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Home My WebLink AboutTR-4046goard Of -SOUTHOLD, NEW YORK Trustees PERMIT NO .... Purs~ fo fhe pmvM~s of Ch~p~e~ 6~5 of'~'he L~ws fhe Sf~fe of New Yerk, 1893; ~¢J C~pfer ~ of f~m Laws fff~ed "REg~ULAT]NG AND THE PLAC~N~ OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS ~.d fhe REMOVAL OF SAND, ~RAVEL OR OTHER NATEA[ALS FROM LANDS UNDER TOWN WATERS;" ~d b ~cco~d~.ce Resoiuf[o~ ~f The ~e~rd edopfed ef ~ meefb~ held o~ .... 19...~.~.., ~md b ¢ons~der~f~o~ o{ fhe sum of $...t50....00. . pMd by o~ .................................................................... N.Y. ~r~d sub]eof fo fhe Terms ~d Co~dffbns ~sfed o~ fhe reverse side hereof, of Soufho~d Towr~ Trusfees ~ufhor~zes ~nd perm[rs fhe to ~egr~de ~ze bA~A ~td. seed as ~er pI~s o~ $~ze Soil and Water Conservatioza District ~]I i~ ~ccord~nce wffh fhe defM[ed specif~c~fions as prese~fed b +he or]gb~fi~9 ~pp{ic~f~om ~N W~TNESS WHEREOF, The sa[d Board of Trusfees h~re- by causes ifs Corpor¢~te Se~ +o be affixed, and +hese presenfs fo be subscribed by ~ m~[orffy of fh.e ~d Board as of fhis daf,e. / ~r~s~ees CASE NUM'_~E.R AC~BER CASE DESCRIPTION CLASS CODE I CASE TYPE I HOW RECEIVED D ~'~FOR SERVICE ,~,~"'~FFICE R INITIATED [] COUNTER REPORT L ~ O c /'¢o.,,'z ~ .¢";.,v) ..~..dT'~,,',,, A NBR STREET N,'~": T [] BLOCK [] COMMERCIAL BLDG. ~ [] INTERSECTION [] INDUSTRIAL BLDG. O [] PRIVATE HOME [] MULTI DWELLING N PERSON INVOLVEM ENI' CODE8 C - COMPLAINANT F - FINDER D - DRIVE R - INJURED / AIDED E - EMPLOYEE J - JUVENILE INCIDENT REPORT Southold Town Police Department Route 25 Peconic. New York 11958 516-765-2600 [~RIMINAL CASE r3 NON CRIMINAL PAGE / Or ? REPORTED DATE OCCURRED ~RO~ / '/'--,>--,~-'~-- TO /--/~- DESK OFFICER PATRO F[,,_~ER [] PUBLIC BLDG. [] SCHOOL [] COUNTRYCLUB/GROUNDS [] PUBLIC PARK [] BANK [] OTHER [] PARKING LOT [] CHURCH M - MISSING PERSON R - REPORTING PERSON V - VICTIM O - OWNER S - SUSPECT W - WITNESS P . POLICE OFFICER U - UNKNOWN Z - OTHER P HRS HRS PERSON LAST NAME FIRST MI [ /z~~DRESS RACE CODES A- ASIAN~ORtENTAL B - BLACK H - HISPANIC - AMERICAN INDIAN O - OTHER W - WHITE PERSON LAST NAME FIRST MI ~..~.~ ADDRESS CODE~ 7~'~HOME'~''''--PHONE/~'/5" ~___...~ [ BUSINESS PHONE I OCCUPATION PERSON L/~ST NAME FIRST MI I ADDRESS CODE HOME PHONE ] BUSINESS PHONE ] OCCUPATION . Narra~ve: (Print er T~e Only) HRS O ,/ PDTS-1A TRUSTFZ' S John M. Bmdemeyer, itI, Pmsidem, ,ajber~ 1 Krupsk[, Jr~, Vke Pmside~t Henry E Smhh John B. Tt,~thilt William G. Albe~Yaon Telepho~e (516) 765-1892 :¢~x (5~6) 765,4823 BOARD OF TOWN TRUSTEES TO~2q OF SOPDfHOLD SUPEP~ViSOR SCOTT L. HARRIS 'tt~Wn Hall 536~5 Main Road EO. Box !179 So'athold, New }~>rk 1 t971 July St 1992 Parker Wickha~ Airway Drive P~O. Box 1312 Mattituck~ NY 11952 Re: Parker Wickhau~ SC[li~ %1000-~i!5,~9-5~ ! Dear Mr ~ Wickha~: The foliowin~ action was taken by the Board of Town Trustees during i'ts regular meeting held on May 28~ 1992 rega~ing the above matter; WHF~EAS~ Parker Wickhe~ applied to the Southo!d To%.a~ Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold~ application dated April 21~ 1992 and~ ~HER~AS said application was referred to the Southold Town Conservation Advisory Council for their findings and reconmaendations~ and~ ~IEREAS, a public hearing was held by the ~own Trustees with res..~ct to said application on May 28, 1992 at which time all interested persons were given an opportunity to be heard, and~ W~Er<EAS, the Board men, ers have personally viewed and are familiar with the premises in question and the surrounding area~ and~ W~EREAS. the Board has considered all the testhmony and docua~entation submitted concerning this apptication, and~ WHE~EAS~ the Board has determined tha't the project as proposed will not affect the health~ safety and genera], welfare of the people of the tovm~ " NOW, THEREFORE BE iT RESOLVED that the Board of Tr~stees approves the application of Parker Wickh~ to regrade the bank and seed. as per plans of the Soil and Water Conservation District. This permit will expire two years from the date it is signed. Fees must be paid, i~ ~liqabl_~e. and permit issued within six months of the date of this notification. ~o inspections are required and the Trustees are to be notified upon completion of said project. Permit will be issued upon pap~aent of 'the fot!owing fees for work to be done below Mean High Water Mark: No fees Very truly John F~o Bredeme}~'er~, President~ Board of Trustee J~lB: jt '~O '~ 41'28./92 Recommendations~.~ n a r~otion by Stephen An§ell, seconded by John McCormick, it was RESOLVED to recommend tovthe Southold Town Trustees a_p_Droval of the application of Parker Wickham 115-9-6.1 & 7 to comply with violation. The CAC recommends approval df the application as long as applican~ follows the soil plan which was submitted. Airway Drive, Mattituck Vote of C0uncil: Ayes: All Motion carried. Page 2 JUDITH T. TERRY TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (5]6) 765-1801 January 29, 1992 To.' From: Re: Valerie Scopaz, Senior Planner Judith Terry, Town Clerkp~'~ Parker Wickham - Wetland Violation In response to your memorandum of January 27, 1992 alleging a violation on the Mattituck Airbase property for which a change of zone petition has been submitted, I am attaching a copy of the map which accompanied the petition, and ask you to delineate on the change of zone parcel exactly where the violation has occurred. Thank you. cc: Town Board Town Attorneys PLANNING BOARD MEMBERS Bennett Orlowski. Jr.. Chairman George Ritchie Latham. Jr. Richard G. Ward Mark S. McDonald Kenneth L. Edwards Telephone (516) 765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 Fax (516) 765-1823 MEMORANDUM: TO: FROM: RE: Date: Judith T. Terry, Town Clerk £ Valerie Scopaz, Town Planner Parker Wickham - Violation $92-0242 Chapter 97-20 SCTM$ 1000-115-9-6.1 & 123-1-1 January 27, 1992 This violation appears to be on Mattituck Airbase property for which a change of zone petition was made by Parker Wickham. How will this violation affect the Town Board's handling of the application and the environmental review in particular. Also, this probably should be brought to the attention of Cramer, Voorhis & Associates for their information. cc: Harvey Arnoff, Town Attorney TRUSTEES John M. Bredemeyer, HI, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 January 23, 1992 Parker J. Wickham Airway Drive P.O. Box 1312 Mattituck, NY 11952 RE: Parker Wickham - Violation ~92-0242- Chapter 97-20 SCTM~1000-115-9-6.1 & 123-1-1 Dear Mr. Wickham: After further consultation with the Town Bay Constable and a site inspection by Trustee(s) it. is the position of this office that, in addition to the requirement of your filing for a permit, you must immediately remediate the site against potential siltation of the adjacent wetland by placing a staked row of haybales at the top of the embankment. Since the ground is hard frozen you will have to auger in the bales and secure them with re-bar or snowfence stakes etc. A minimum of 2 stakes per bale is required and several haybales are to be staked as landward returns to prevent run-off from short circuiting around the barrier. No additional work is to be done in the disturbed area or within 75' of any wetlands onsite until the entire Board of Trustees has had an opportunity to contemplate your permit application and visit the site. Based on the information to date, you should expect the requirement of a substantial remediation, including possible total removal of all materials placed in this wetland. If this office can be of further assistance, please do not hesitate to contact this office. Very truly yours, M. Bredemeyer, III President, Board of Trustees cc: Town Attorney, Town Planning, Bay' Constable TRUSTEES John M. Bredemeyer, 1II, President Henry P. Smith, Vice President Albert I. KrUpski, Ir. IMm L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 January 23, 1992 Parker J. Wickham Airway Drive P.O. Box 1312 Mattituck, NY 11952 RE: Parker Wickham - Violation 992-0242- Chapter 97-20 SCTM~1000-115-9-6.1 & 123-1-1 Dear Mr. Wickham: After further consultation with the Town Bay Constable and a site inspection by Trustee(s) it is the position of this office that, in addition to the requirement of your filing for a permit, you must immediately remediate the site against potential siltation of the adjacent wetland by placing a staked row of haybales at the top of the embankment. Since the ground is hard frozen you will have to auger in the bales and secure them with re-bar or snowfence stakes etc. A minimum of 2 stakes per bale is required and several haybales are to be staked as landward returns to prevent run-off from short circuiting around the barrier. No additional work is to be done in the disturbed area or within 75' of any wetlands onsite until the entire Board of Trustees has had an opportunity to contemplate your permit application and visit the site. Based on the information to date, you should expect the requirement of a substantial remediation, including possible total removal of all materials placed in this wetland. If this office can be of further assistance, please do not hesitate to contact this office. Very truly yours, M. Bredemeyer, III President, Board of Trustees cc: Town Attorney, Town Planning, Bay Constable TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert I. Kmpski, Ir. lohn L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 Fax (516) 765-1823 ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTt L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION I Office Use Only: ;~Coastal Erosion Permit Application L~rWetland Permit Application ~Trustee Lands Permit Application ~Grandfather 7Completed Apps. Date: ~Variance Required, ~Neighbors notified Dat^e: Coord. Review-opt.,mand. · Insp. comp./date: SEQRA Determin./date: · Public Hearing/date: Findings: Permi5 Vote: (Y/N): Special Conditions: (also see file) LD Application Fee: Application Number; SCTM ~1000-%-l,~_.e::~_~.(~ Project Name (If any) Date Prepared: ~ ~ / - ~7--- Applicant: ~3~ /~/~/~-~ (/~/C/-~/~ Phone (~-~) ~_. ~~ Interest: (owner, consultant,lessee,etc. ) ~~~ Owner of Property: ~/~ _~~J~.. /~//C/<~~ Address ~rl~,.P~ ~/~... _~~/~Oc[~ ~. ~. Phone (~/&) ~_ V~C/f Subject Property Location: ~~ ~D ~' /~0~ (2~oviae ~Z~CO PoZe ~, ~Zsta~oe to c~oss St:eets ~ ~ot o~ location map) THIS IS NOT A PERMIT Yds. to be excavated: ~O~ ~g' Yds. ~c_.bc filled: Manner in which material will be removed or Width of canal, creek or bay fronting proper~--_~:~ Depth at low ti4~-------- Aver. rise in t~i~c: Distance to nearest chanm~--.=-~ Dista~e prcjcot extends beyond similar projects Area zoning: Land area in acres: Is project for private or business use: Intended use of property:~/~c~ ~ ~ ~(~%~U Describe known prior 'operations conducted on premzses: Has any prior, license or permit been issued.to~ect struc=ures, dredge, or-deposit fill on said Premises: Has any license or permit ever been revoked or suspended by a Governmental Agency: ~0 Project Description The project description must also include plans for reclamation of land disturb~g~~ction of the principle and accessory structure~rground structures.(i.e., pipeline and septic sys~e addi~l attachments if necessary). I . _ ~ r~ding at (Print-owner 0~~e~tproperty) (Mailing address-phone) ~o hereby authori~ - _ _~~ to apply for Coastal Erosion/permit(s) fro~e Southold Town Trustees / Sight, re THIS IS NOT A PE~IT County of Suffolk ) State of New York ) ~.~ iC.,~2.~f%,%~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/,S~ IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(s) OR REPRESENTATIVE(s), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. / d~../ SI GNATU-R~ ' SWORN TO BEFORE ME THIS DAY OF NOTARY PUBLIC ¥~RON~CA ~. TABORS~ ~TARY PUBL~, ~t~ of N~ No. 52~51~ Suffolk ~ Suggested space for location Map THIS IS NOT A PERMIT 4-16-2 (2/87)-- 7c 617.21 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT Purpose: 1'he full EAF is designed to help applicants and agencies determine, in or action may be significant 'lhe question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a prolect thal are subjective or unmeasureable, t is also understood that those who determine significance may have litlle or no formal knowledge of the environment or may be technicall~ expert in environmental analysis. In addition, many who have knowledge itl one particular area mav not be aware of the broader concerns affecting tile question of significance 1he full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly', com0rebensive in nature, yet flexible to allow introduction of information to fit a project or action. Full lEAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacts that may occur from a project or action It provides guidance as to wh~'ther an impact is likely to be considered small to moderate or whether it is a potentially- large impact. The form also identifies whether an impact can be mitigated or reduced. Parl 3: If any impact in Part 2 is identified as potentially-large, then Part3 is used to evaluate whether or not tile impact is actually' important. DETERMINATION OF SIGNIFICANCE--Type 1 and Unlisted Actions IdentiFy the Portions of EAF completed for Ihis project: I~ Part 1 [] Part 2 E]Part 3 Upon review of the information recorded on this FAF (Parts I and 2 and 3 if appropriate), and any other supporting information, and considering both the magitude and importance of each impact, it is reasonably determined by the lead agency that: A. The project will not result in any' large and important impact(s) and, therefore, is one which will not have a ~ignificant impact on the environment, therefore a negative declaration will be l~'l~ar~d. - [] B. Although the project could have a~i'gnificant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PARI 3 have been required, therefore a CONDIIIONED negative declaration will be prepared.* [] C. Tile project may result in one or more large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. * A Conditioned Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or TypeAName of Responsible Officer in/Lead Agency Signa~e of Responsiblc~-Officer in Lgfad)gency Date Title of Responsible Officer Signature of Preparer (If different from responsible officer) PART 1--PROJECT INFORMATION ..... ~:~ Prepared by Proiect Sponsor NOTICE: Thisrlocument is designed to assist in deterrniningwhether the action proposed may have a si§nificant effect on tile environment. Please complete tile entire form, Parts A througt~ E. Answers to these questions will be considered as part of tile application for approval and may be subject to further verification and public review. Provide any additional information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance, NAME OF ACTION LOCATION OF ACTION (Include Slreet Address, Municipality and County) NAME OF APPLICANT/SPONSOR BUSINESS TELEPHONE ADDRESS CITY/PO ISTATE ZIP CODE NAME OF OWNER (If different) BUSINESS TELEPHONE ( ADDRESS CITY/PO ZIP CODE STATE DESCRIPTION OF ACTION Please Complele Each Question-Indicate N.A. if not applicable A. Site Description Physical setting of overall proiect, both developed and undeveloped areas. 1. Present land use: [~Orban EJlndustrial ~[Commercial [~Residential (suburban) [Z]Forest E]Agriculture E]Other 2. Total acreage of project area: ~' acres. APPROXIMATE ACREAGE Meadow or Brushland (Non-agricultural) Forested Agricultural (Includes orchards, cropland, pasture, etc.) Wetland (Freshwater or tidal as per Articles 24. 25 of ECL) Water Surface Area Unvegetated (Rock, earth or fill) Roads. buildings and other paved surfaces Other (Indicate type]_ 3. What is predominant soil type(s) on project site? E]Rural (non-farm) PRESENTLY AFTER COMPLETION acres n ac~es ::::: · acres acres ,,{",~ ~ / acres acres A./2~: ~.~"~ acres acres 2~ acres a Soil drainage: J~Well drained ~,~/ % of site E]Moderatelv well drained % of site [.:]Poorly drained % of site b If any agricultural land is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS l_and Classification System? acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? E]Yes a What is depth to bedrock? (in feet) 5. Approximate percentage of proposed ~roiect site with slopes: E]0-10% % [310-15% % .q~115% or greater % 6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the National Registers of Historic Places? L~Yes ~No 7. Is project snbstantiallv contiguous to a site listed on the Register of National Natural Landmarks? ~Yes ~'No 8 What is the depth of tile water table? /,9'""~' (in feet) 9. Is site located over a primary, principal, or sole source aquifer? ~]Yes ~rNo 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? [~Yes '~No 11 Does project site contain any species of plant or animal life tilat is identified as threatened or endangered? According to Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) ~Yes ~No Describe 13. Is the project site presently used by the cornmunity or neighborhood as an open space or recreation area? LqYes [~No If' yes, explain 14. Does the present site include scenic views known to be important to the community? E3Yes ~No '15. Streams within or contiguous to project area: a Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland areas within or contiguous to project area: a Name 17. Is the site served by existing public utilities? I~Yes I~No a) If Yes, does sufficient capacity exist to allow connection? b) If Yes, will improvements be necessary to allow connection? b. Size (In acres) ~Yes E3No i-lYes UINo 18. Is the site located m an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? [~Yes [:lNo 19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 6177 E3Yes [::]No 20. Has the site ever been used for tile disposal of solid or hazardous wastes? ~Yes '~,No B. Project Description 1. Physical dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled bv project sponsor b. Project acreage to be developed: acres initially; c. Protect acreage to remain undeveloped acres. d. l_ength of project, in miles: (If appropriate) e. If tile project is an expansion, indicate percent of expans.ion proposed %: f. Number of off-street parking spaces existing ; proposed g. Maximum vehicular trips generated per hour (upon completion of project)? h. If residential: Number. and type of housing units: One Family Two Family Multiple Family Initially Ultimately i. Dimensions (in feet) of largest proposed structure height; width; i. Linear feet of frontage along a public thoroughfare prolect will occupy is? ft. acres. acres ultimately. Condominium length. much natural material (i.e.; rock, ~rth, etc.)will be removed from the site? 2. How 3. Will disturbed areas be reclaimed? [-;]Yes []No L~N/A a. If yes, for what intended purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? UYes E3No c. Will upper subsoil be stockpiled for reclamation? E3Yes ~lNo 4. How many acres of vegetation /trees, shrubs, ground covers) will be removed from site? acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? UYes E3No 6. If single phase project: Anticipated period of construction 7. If multi-phased: a. Total number of phases anticipated (number). b. Anticipated date of commencement phase 1 c. Approximate completion date of final phase d. Is phase 1 functionally dependent on subsequent phases? 8. Will blasting occur during construction? I-lYes E3No 9: Number of jobs generated: during construction 10. Number of jobs eliminated by this project 11. Will proiect require relocation of any projects or facilities? tons/cubic yards months, (including demolition). month year, (including demolition). month year. I-lYes [3No ; after project is complete I-lYes r-lNo If yes, explain 12. Is surface liquid waste disposal involved? E3Yes [-'lNo a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? [Yes [3No Type 14. Will surface area of an existing water body increase or decrease by proposal? Explain i-lYes I-1No 15. Is project or any portion of project located in a 100 year flood plain? 16. Will the project generate solid waste? [3Yes E3No a. If yes, what is the amount per month tons b. If yes, will an exis-ting solid waste facility be used? [Yes I-1No c. If yes, give name ; location d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? e. If Yes, explain I-lYes E3No i-lYes i-lNo 17. Will the project involve the disposal of solid waste? E3Yes a. If yes, what is the anticipated rate of disposal? b. If yes, what is the anticipated site life? years. 18. Will project use herbicides or pesticides? []Yes E3No I-]No tons/month. 19. Will project routinely produce odors (more than one hour per day)? E3Yes 20. Will project produce operating noise exceeding the local ambient noise levels? 21. Will project result in an increase m energy use? I-lYes ~No If yes . indicate type(s) E3No ~Yes E]No 22 If water supply is from wells, indicate pumping capacity 23. Total anticipat.ed water usage per day gallons/day. 24. Does project involve Local, State or Federal funding? [3Yes If Yes, explain gallons/minute. UNo :25. Approvals Required: City. 'town, Vilh~k [h:,ard [_-lYes E_]No City, Town. Village Flarming Board [_-l. Yes F_]No City, Town Z~,mm,, Board ~Yes City, County ite,:'.lh Department ~Yes Other Local Agencms []Yes Other Regional Agencies ~]Yes L]No State Agencms ~lYes [~No Federal Agencies ~Yes ~No Zoning and Planning Information Does proposed action involve a planning or zoning decision? E3Yes If Yes. indicate decision required: L~]zoning amendment ~zoning variance ~special use permit [~]new/revision of master plan L~resource management plan What is the zoning classification(s)of the site? Type Subr~iHal Date [-JNo ~subdivision ~site plan [-_1other 3 What is file maximum potential development of the site if developed as permitted by the present zoning? 4 What is tile proposed zoning of the site? 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? E}Yes i-INo 7. What are the predominant land use(s) and zoning classifications within a 'A mile radius of proposed action? 10 11 12 Is the proposed action compatible with adjoining/surrounding land uses within a ~/~ mile? gYes F'INo If the proposed action is the subdivision of land, how many lots are proposed? a. What is the minimum Jot size proposed? Will proposed action require any authorization(s) for the formation of sewer or water districts? [~Yes E3No WiJl the proposed action create a demand for any community provided services (recreation, education, poJice, fire protection)? E]Yes E-~No a. If yes, is existing capacity sufficient to handle projected demand? E]Yes E]No Will the proposed action result in the generation of traffic significantly above present levels? E]Yes f-INo a. If yes, is the existing road network adeq~jate to handle the additional traffic? I-lYes E]No D. Informational Details .~ Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. ,- E. Verification I certify that the information provided above is true to the best of my knowledge. Applicant/Sponsor Name Date Signature Title If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment. 5 Part 2--PROJECT IMPACTS AND THEIR MAGNITUDE Resp(msibilily o[ Lead Agency General Informalion (Read Carefully) · In ('(m;l~h'ting tim form the rr, viewor should be guided by the question: Have my response~ and de. terminations been reasonable? 'the reviewer is not expected to }m an e×pm't environmental analyst. · identifying that an impact will be potenti~llv large/column 2) does not mean that it is also necessarily si~.-.ificant. Any large impact nm~t be evaluated in P&Ri' 3 to determine significance. Identifying an impact in ' (,d~mm 2 simply asks that it.be looked at furtlmr · 1'he Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout tim State and for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate for a Potential I_arge Impact response, thus requiring evaluation in Part 3. · The impacts of each projecL on each site, in each locality, will vary. Therefore, the examples are illustrative and have been offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to answer each question. · The number of examples per question does not indicate the importance of each question. · In identifying impacts, consider long term, short term and cumlative effects. Inslrudions (Read carefuiiy) , a. Answer each of the 19 questions in PART 2. Answer Yes if there will be any 'impact. " b. Maybe answers should be considered as Yes answers. c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the impact If impact threshold equals or exceeds any example provided, check column 2. If impact will occur but threshold is'lower than example, check column 1. d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate indicates that such a reduction is not possible. This impact, also check the Yes box in column 3. A No response must be explained in Part 3. IMPACT ON LAND 1. Will the proposed action result in a physical change to the project site? gNO F1YES Examples that would apply to column 2 · Any construction on slopes of'15% or greater, (15 foot rise per 100 foot of length), or where the general slopes in the project area exceed 10%. · Construction on land where the depth to the water table is less than 3 feet. · Construction of paved parking area for 1,000 or more vehicles. · Construction on land where bedrock is exposed or generally within 3 feet of existing ground surface. · Construction that will continue for more than 1' year or involve more than one phase or stage. · Excavation for mining purposes that would remove more than 1,000 tons of natural material (i.e., rock or soil) per year. : · Construction or expansion of a sanitary/ landfill. · Construction in a designated floodway. · Other impacts 2. Will ti]ere be an effect to any unique or unusual land forms found on the site? (i.e., cliffs, dunes, geological formations, etc.)E~NO [~YES 6 · SPecific land forms: I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] E]Yes []No [] [] []Yes []No [] [] [~Yes [~No [] [] []Yes []No [] [] []Yes []No [] [] I-lyes []No ~ ~ ~Y.s ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No IMPACT ON WATER 3 Will proposed action affect any water body designated as protected? (Under Articles 15, 24. 2.5 of the Environmental Conservation Law, ECL) []NO I-lYES Examples that would apply to column 2 · Developabh; area of site contains a protected water bodv. · Dredging more than 100 cubic yards of material from channel of a protected st~ear-n. · [-.xtension of ulilitv distribution facilities through a protected water body. · Construction in a designated freshwater or tidal wetland · Other m~pacts: 4 Will proposed action affect any non-protected existing or new body of water? E]NO ~YES Examples that would applv to column 2 · A 10% 'ncrease or decrease in the surface area of any body of water or more than a 10 acre increase or decrease, · Construction of a body of water that exceeds 10 acres of surface area. · Other impacts: 5. Will Proposed Action affect surface or groundwater quality or quantity? E3NO [1YES Examples that would apply to column 2 · Proposed Action will require a discharge permit. · Proposed Action requires use of a source of water that does not have auproval to serve proposed (project) action · Proposed Action requires water supply from wells with greater than 45 gallons per minute pumping capacity. · Construction or operation causing any contamination of a water supply system. · Proposed Action will adversely affect groundwater. · Liquid effluent will be conveyed off the site to facilities which presently do nol exist or have inadequate capacity. · Proposed Action would use water in excess of 20.000 gallons per day. · Proposed Action will likely cause siltation or other discharge into an existing body of water to the extent that there will be an obvious visual contrast to natural conditions. · Proposed Action will require the storage of petroleum or chemical products greater than 1,100 gallons. · Prol~osed Action will allow residential uses in areas without water andlor sewer services · Proposed Action locates commercial a'nd/or industrial uses which may reqtnre new or expansion of existing waste treatment and/or storage facilities. · Other impacts: 6 Will proposed action alter drainage flow or patterns, or surface water runoff? E]NO E]YES Examples that would apply to column 2 · Proposed Action would change flood water flows 7 I 2 3 Smallto Potential Can Impact Be Moderate Large Miti~;ated By Impact Impact Project Change [] [] []Yes []No [] ~1 []Yes []No [] [] []Yes []No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~J ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~ ~ ~Yes ~No ] ~ ~ ~Yes ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No [ ~ ~ ~Yes ~No. ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No~ · Proposed Action may cause substantial erosion. · Proposed Action is incompatible with existing drainage patterns. · Proposed Action will allow development in a designated floodway. · Other impacts: IMPACT ON AIR 7. Will proposed action affect air quality? E~NO r-lYES Examples that wot,Id apply to column 2 · Proposed Action will induce 1,000 or more vehicle trips in any given hour. · Proposed Action will result in"the incineration of more than 1 ton of refuse per hour. · Emission rate of total contaminants will exceed 5 lbs. per hour or a heat source producing more than 10 million B~[U's per hour. · Proposed action will allow an increase in the amount of land committed to industrial use. · Proposed action will allow an increase in the density of industrial development within existing industrial areas. · Other impacts: IMPACT ON PLANTS AND ANIMALS 8. Will Proposed Action affect any threatened or endangered species? [_-3 NO ~YES Examples that would apply to column 2 · Reduction of one or more species listed on the New York or Federal list, using the site, over or near site or found on the site. · Removal of any portion of a critical or significant wildlife habitat. · Application of pesticide or herbicide more than twice a year, other than for agricultural purposes. · Other impacts: 9. Will Proposed Action substantially affect non-threatened or non-endangered species? I~NO ~YES Examples that would apply to column 2 · Proposed Action would substantially interfere with any resident or migratory fish, shellfish or wildlife species. · Proposed Action requires the removal of more than 10 acres of mature forest (over 100 years of a~e) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES 10. Will the Proposed Action affect agricultural land resources? E~NO U]YES Examples that wo'uld apply to coh, mn 2 · '[he proposed action would sever, cross or limit access to agricultural land (includes cropland, hayfields, pasture, vineyard, orchard, etc.) I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] []Yes E~No [] [] []Yes [~No [] [] []Yes [~No [] [] []Yes E]No [] [] []Yes E~No [] [] []Yes []No [] [] [~Yes []No [] [] ElVes I-]No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~. ~Yes' ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No · Construction activity would excavate or compact the soil profile of agricultural land. · The proposed action would rrreversibly convert more than 10 acres of agricultural land or, if located in an Agricultural District, more than 2.5 acres of agricultural land. · The proposed action would disrupt or prevent installation of agricultural land management systems (e.g., subsurface drain Pines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) · Other impacts: IMPACT ON AESTHETIC RESOURCES 11 Will proposed action affect aesthetic resources? I-INO I-lYES (if necessary, use the Visua EAF Addendum in Section 617.21, Appendix B.) Examples that would apply to column 2 · Proposed land uses, or project components obviously different from or m sharp contrast to current surrounding land use patterns, whether man-made or natural. · Proposed land uses. or project components visible to users of aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. · Project components that will result in the elimination or significant screening of scenic views known to be important to the area. · Other impacts: IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12 Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? [Z]NO E]YES Examples that would apply to column 2 · Proposed Action occurring wholly or partially within or substantially contiguous to any facility or site listed on the State or National Register of historic places. · Any ~mpact to an archaeological site or fossil bed located wid~in the project site. · Pror~osed Action will occur in an area designated as sensitive for archaeological sites on the NYS Site Inventory. · Other impacts: IMPACT ON OPEN SPACE AND RECREATION 13 Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 ~NO [Z1YES · The permanent foreclosure of a future recreational opportunity. · A major reduction of an open space important to the community. · Other impacts: I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] I []Yes E~No [] [] I-lYes []No [] [] []Yes UNo [] [] []Yes []No [] [] []Yes []No [] [] []Y~s i-INo [] [] ~¥es I-INo [] [] ~Yes I-1No [] [] I-lYes I--INo ~ ~ ~Ves ~No ~ ~ ~Ves ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No IMPACT ON TRANSPORTATION 14. Will there be an effect to existing transportation systems? []NO []YES Examples that would apply to column 2 · Alteration of present patterns of movement of people and/or goods, · Proposed Action will result in major traffic problems, · Other impacts: IMPACT ON ENERGY 15. Will proposed action affect the community's sources of fuel or energ,v supply? L~NO I-]YE S Examples that would apply to column 2 · Proposed Action will cau,se a greater tt~an 5% increase in the use of any form of energy in the municipality. · Proposed Action will require the creation or extension of an energy transmission or supply system {b serve more than 50 single or two family residences or to serve a major commercial or industrial use. · Other impacts: NOISE AND ODOR IMPACTS 16. Will there be objectionable odors, noise, or vibration as a result of the Proposed Action? [-3NO [5]YES Examples that would apply to column 2 · Blasting within 1,500 feet of a hospital, school or other sensitive facility. · Odors will occur routinely (more than one hour per day). · Proposed Action will produce operating noise exceeding the local ambient noise levels for noise outside of structures. · Proposed Action will remove natural barriers that would act as a noise screen. · Other impacts: IMPACT ON PUBLIC HEALTI-! 17. Will Proposed Action affect public health and safety? E3NO ~YES Examples that would apply to column 2 · Proposed Action may cause a risk of explosion or release of hazardous substances (i.e. oil, pesticides, chemicals, radiation, etc.) in the event of accident or upset conditions, or there may be a chronic Iow level discharge or emission. Proposed Action may result in the burial of "hazardo0s wastes" in any form (i.e. toxic, poisonous, highly re.active, radioactive, irritating, infectious, etc.) Storage f~lcilities for one million or more gallons of liquified natural gas or other flammable liqtiids. Proposed action may result in the excavation or other disturbance within 2,000 feet of a site used for the disposal of solid or hazardous waste. Other impacts: 10 1 2 3 Small to Potential Gan lmpaot Be Moderate Large Mitigated By Impact Impact Project Ghange [] [] []Yes []No [] [] []Yes []No [] [] []Yes E~]No [] [] i-lYes [~]No [] [] []Yes [~No [] [] []Yes []No [] [] I-lYes []No [] [] []Yes []No [] [] []Yes []No [] [] []Yes. [~No [] [] []Yes []No [] ~ ~Yes ~No ~ '~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~NO ~ ~ ~Yes ~No IMPACT ON GROWTH AND CHARACTER OF COMMUNITY OR NEIGHBORHOOD 18 Will proposed action affect the character of the existing communit\,? ~NO []YES £xamples that would apply to column 2 · The permanent population of the city, town or village in which the project is located is likely to grow by more than 5% · The municipal budget for ~:apital expenditures or operating services will increase by more than 5% per vear as a result of this project. · Proposed action will conflict with officially adopted plans or goals. · Proposed action will cause a change in the density of land use. · Proposed Action will replace or eliminate existing facilities, structures or areas of historic mportanceto the community. · Development will create a demand for additional community services (e.g. schools, police and fire, etc.) · Proposed Action wil set an important precedent for future projects. · Proposed Action will create or eliminate employment. · Other impacts: 19 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] []Yes []No [] [] []Yes 'l-[No [] [] f-lYes []No [] [] I-lYes i--1No [] [] I--lYes r-]No [] [] []Yes l-lNo [] [] []Yes []No. [] [] []Yes []No' [] [] [---]Yes []No Is there, or is there likely to be. public controversy related to potential adverse environmental impacts? []NO l-lYES If Any Action in Part 2 Is Identified as a Potential Large Impact or If You Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3--EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1. Briefly describe the impact. 2 Describe [if applicable] how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3, Based on the information available, decide if' it is reasonable to conclude that this impact ~s important. To answer the question of importance, consider: · The probability of the impact occurring · The duration of the impact · Its Irreversibility, including permanently lost resources of value · Whether the impact can or ~vill be controlled · The regional consequence of the impact · Its potential divergence from local needs and goals · Whether known objections to the project relate to this impact. (Continue on attachments) 11 t .A 0