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HomeMy WebLinkAboutTR-4409,upski, President )fei. Vice President .m King larun H. Garretl Peter Wencze[ Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD ---~ffice Use Only Coastal Erosion Permit Appli. ----Wetland Permit Application . Grandfat~~ App!~catlon y-----_~ver~-~endme~Changes ~ L~Re~e~ved A~~- ~eceived Fee:$ /~ ~pleted Applicatzon_ incompiete SEQ~ C~as~i~ica~ion:_. ~ ~ ~e II Unizsnea coor~in~tion:(date sent)_ ~A~ Referral Sent: ~te of inspection] ~aceipt of CAC ~-~ad Agency Determlnat~on- '-Technical Review: ~p~!ic Hearing Held: esolution: Name of Applicant_ ~ Address ' Suffolk county TaX Map N~er: [000 proper%y Location:~ ~vide hILCO Po~ distance AGENT:~ (If applicable) Address: Phone: FAX~: ~rd of Trustees Applicati¢ GENERAL DATA Land Area (in square feet): Area Zoning: ~ ~ Previous use of property: Intended use of property: Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): 5 rd of Trustees Applicatio WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~ ~O~ ~-o~ Area of w~ttands on lot: ~ O ~ square feet Percent coverage of lot: -- 0-- % Closest distance between nearest exist£~g structur~and mola~d edge of wetlands: ~ feet Closest distance between neares~ proposed structure and upland edge of wetlands: /~O feet Does the project involve excavation or filling? '~. No ~/ Yes ~ ~ cubic yards cubic yards If yes, how much materiai will be excavated? How much material will be filled? Depth of which material wi~l b~e removed Qr deposited: fe~t ~+o ~-~ .~ Proposed slope throughout the area of operations: D Manner in which material will be removed or depo~sited: Statement o~ the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): · 14-16-,~ (2JB~--Text 12 · , PROJECT LD. NUMBER 6 t 7.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT iNFORMATION (To be completed by Applicant or Proiect spBnsor) I. APPLJC~T/~PONSOR ( 3. PROJECT LOCATION: ' ' 4. PRECISE LOCATION (Street address and road in[ersections, prominent landmarks, etc., or provide 5. IS PROPOSED ACTION: ~ New ~ Expansion 7. AMOUNT OF LAND AFFECTED: lnitfa~[y ~ ~'~ acres Ultimately ¢, ~0 acres 8. W!LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~.es ~ NO Ii' NO, describe briefly 'WHAT iS PRESENT LAND USa iN VICINITY, OF PROJECT? [] Residential [] Industrial '~'~Commerc a ,Describe: r~ Agriculture L~ Other DOES ACTION iNVOLVE'A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STA~,_5~ LOCAU? DOES ANY ASRECT OF THE ACTION HAVE ~A~CURRENTLY VALID PERMIT OR APPROVAL? 12. AS A RESULT OF PROPOSED ACT]ON WILL EXISTING PERMIT/APPROVAL REQUIRE MOOIFICAT~ON? THAT THE INFORMATION PROVIDED ABOVE iS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: S[gna[ure: if the action is in the Coastal Area, and you are a state ~.gency, complete .',he Coastal Assessment Form before proceeding with this assessment OVER 1 PART ii--ENViRONMENTAL AS~S~_SSMENT (To be completed by Agency} A, DOES ACTION EXCEED ANY TYPE tRESHOLD IN 6 NYCRR, PART 617.127 tf yes, oe~ .mate the review process And use the F;~LL E"AF.. n~ Yes ~ NO S. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTrONS IN 8 NYCRR, PART 8I?_57 If No, a negative dectaraticr may de superseded by another involved agency. [] Yes ~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Ans-,vers may be handwritten, if legible) O1. Existing a~r quality, surface or' groundwater Duality or quantity, noise levels. ~x~sting traffic oa~tems, solid ~¢aate ~roouc~on or dlSDOSa~ ootentle. I for erosion, drainage or flooding oroblems? ¢.xnlain briefly: 03. Vegetation or fauna, fish. sheitfish or wild!ifa species, significant habitats, or threatened or endangered species? Ex:2tein drlefly: 04. A community's existing glans or goais as officially Caddied. er a change m use or intensity of use of land or other natural resources? Exmam orlet C5. Growth, suosequen[ cave,cement, or related activities likely ,,o De induced Dy the oropased action? ExetaJn briefly. C~. Long term. snor[ term. cumulative, or omar effects not identified tn C1-C57 ExPlain briefly. C7. Other imoacte encircling Changes n use of either quantity or [ype o~ energy}? Explain briefly. O. ;S THERE. OR IS THERE LIKELY TO SE, CONTROVE.~SY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL iMPACTS? ~ Yes [] No f Yes~ ex,lain ~riefly PART III--DETERMINATION OF SIGNIFICANCE (To De compieted oy Agency) INSTRUCTIONS: For each adverse effect identified a~)ove, determine wnemer it is substantial, large, imoor~ant or othe.,~4se significan- Each effect should ~e assessed in connec~or with ~ts Iai setting (La. uroa~ or tufa0; (b) pro0amlity of OCCU.~.tDg; (.C) duration: irreversibiiity; (e) geograonlc scope: and (f) magmtude, if necessary, adp attachments or reference supporting materials. Ensure tho exotanations cantata sufficient dezaiI to snow that all relevant adverse ~rno~cts have Dean identified and adequ~.[el'y addressed. Check this box if you nave identified one or more ootentially large or significant adverse imoacts which MAY occur. Then proceed directly [o the FULL EAF and/or prepare a positive-declaration. Check this POX 'f yOU ,have determined, based on the information a~d analysis above and an'/ supoortin~ documentation, that the proposed action WILL NOT result in_-~.~y significant ~dverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determinaUon: -' 2 Board Of $outhold -Town Trustees SOUTHOLD, NEW YORK PERMIT NO. I (.l~ DATE: ISSUED TO ..... ST RO.NG!S ,MARINE INC. Pursuant to the provisions of Chapter 615 of the Laws of the State of New Yorl~, 1,893; and C.hapter 404 of the Laws of the State of New York 1952 and the Soufhold Town Ordinance eh- rifled "REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND GRAVEL O,R, OTH.ER MATERIALS FROM LANDS UNDER TOWN WATERS;! and in accordance with the Resolution of The Board adopted at a meeting held on 1/20/.95 .. 19.9_~..., and in consideration of the sum of $.150.00 paid by . .Jeffery .Strong fozc STRONG'S, MARINE I.l~C. .... o{ ..... MatIi.tuck ............ N, Y, and subject to the Terms fha reverse side hereo{, ifs the follow,ne: RESOLVED, that the Board of Trustees a roves STRONG'S MARINE IN~ .~. ~ ..... , PP the application of small floating dock s__,~ ~_~u.~uuse g.u~£nzng, slate patio, , storage blocks), a stockade fence(Separates parking area), 'stockade fenced ares for dumpster~ '3 ~terage sheds, a plastic ' work shed, a proposed f~ture shop that would eliminate plastic shed and ~ storage sheds, existing boat storage racks (north & south) recently filled dirt areas to berms,~in addition, the grade On this area will be raised apProx~ ~ in the f~t~re. This fill will come from ~redging on the south side for new ere- b~lkhead that Ti-ustees have already approved, and a ~_~, house S tO with pump-out station. It should be noted that Strong s azt~onal pavement Where the p~oposed-.~ew ~acks are. It is als~ u-nde~to0d that grading this with gravel is an accet and Permitted use in the future '~ .... ~ i .. p able Southold Town Board of Trustees November 12, 1994 As per your request, attached please find a survey showing all improvements as they exist on the property as of October 22, 1994, As you consider granting us a permit for the areas to be discussed, we ask that you waive ns from the normal S. T. B, T. policy. Thus allowing you to grant us these permits first. This letter will serve as an addendum to our original application dated October 26, 1994 which requested a permit to replace 75' of existing bulkhead and to construct 190' of new boat storage racks. It should be onderstood by all that most of these ~mprovements have happened over the last 25 years. The intent of all involved is to be sure that the property survey is current and correct, that all existing improvements be understood and correctly permitted and that by having this, any new additions that are to be considered will be added to this survey and permits requested for. We hereby request Permits for the following: A. Original application - Errection of 190' of boat storage racks B. Original application - Replacement of 75' of existing bulkhead I. Clubhouse building 2. Slate patio 3. Small floating dock 4. Small gazebo 5, Stockade fence (hides boat storage blocks) 5a. Stockade fence (separates parking area) 6. Stockade fenced area for dumpster 7, Storage shed 8, Storage shed 9. Storage Shed 10. Plastic work shed lOa. Proposed future shop that would eliminate plastic shed and two storage sheds (highlighted in green/yellow) 11. Existing boat storage racks (south/ 12. Existing boat storage racks (north) 13. Recently filled dirt area tO ber~n 14~ Recently filled dirt area to berm 14a. In addition, the grade on this area will be raised approximately 1' in the future. This fill will come from dredging on the soutbside for new bulkhead that T~stees have already approved. 15. Gas house with pump out station. It should be noted that Strong's Marine Inc. understand that the Trustees do not want any additional pavement where the proposed new racks are~ or where the newly filled areas for parking and storage are (#A, #13, #141. ' It is also future,understood that grading this with gravel is an acceptable and permitted use in the If there are any questions at agl please give me a call. Our team at Strong's currentMarine appreciates standards, the Thank Trustees you. diligence in trying to help us get everything up to Jeffery L. Strong i ' rd of Trustees Applicatio' 'i County o~ Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE IS THE/APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEStEIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE .AND BELiF~, AND THAT ALL WORK WILL BE DONE IN THE M_INNER 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 TH~. TOWN TRUSTEES HARMLESS AND FREE FROM ANY_ AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRT~JE OF SAiD PFJA~IT(S), IF GRA~NTED. IN COMPLETING THIS APPLICATION, i HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT ( S ) OR REPRESENTATIVES ( S ), TO ENTER ONTO MY PROP~RTY TO INSPECT THE PRF~!SES IN CONJUNCTION WITH REVIEW OF THIS ~oPLICATION. SWORN TO BEFORE ME THIS Notar~ Public · Albert J. Kmpski, President John Holzapfel, Vice President William G. Albertson - ~- Mm'fin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~ Wetland Permit Application · Grandfather Pezmit Application Trustee Lands Permit Application Waiver /~ /q~ . Received Application: Clerical Review: Completed Application Incomplete --SEQRA Classification: Type I_~__Type II Unlist( ~_Coordination:(date s ~ CAC Referral Sent: ~t ~_Date of Inspection: ~ Receipt of CAC Report:( ~ Lead Agency Determination: !~_Technical Review:(date ii.A/ Public Hearing:(date)' |Decision: Approved (Y7 ]~ Application Fee: $/~--~7~ Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 Name of Applicant ~'~"'©'f%~'5 ~/~ O_~.~-~ fx,~., x'~.%9% q-~ ~one ~er- ~/~ ) ~ ~-- ~ ~ ~ Suffolk County Tax Map N~ber: 1000 - }~ff~ ~% ~ oc, on: (provide L!LCO Pole ~, distance to cross streets, and location) Agent: (if applicable) Address: Phone: 1 Bo~.~d of TruStees Application GENERAL DATA Land Area (in square feet): Area Zoning: ~~ Previous use of property: Intended use of property: Prior permits/approvals for Site improvements: Agency Date  No prior for improvements. permits/approvals site Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No__ Yes If yes, provide eXplanation: Project Description (use attachments if necessary): BO~d of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:~ ~ f>~ ~~c~'.e_ Area of wetlands on lot: square feet Percent coverage of lot: O % Closest distance between nearest existing struct~ure an,~, u~l~nG[U nd edge of wetlands: 57 feet ~ ~--o 613 ~ ~~~ Closest distance betw,e~n nearest proposed structure and upland edge of wetlands: ~?0 feet Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated? ~ c~ic yards How much material will be filled? ~O c~ic yards Depth of which ~will be removed or deposited: ~ ~ feet ~ ~[~ ~ ¢~~) Manner in which material Will be removed or deposited: / Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attac~ents if appropriate): 6 ~, ' 1~-1~-4. (2/8~)--Text 12 ~ ' ~ PRbJEOT i.D. NUMBER 1 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by Applicant or Project spbnsor) SEQ 1. APPLICAN~T~/E,~P~NSOR 2. PROJE.CT NAME~ 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc. or provide map) 5, IS PROPOSED ACTr~,~ [] New ~ Expansion [] Modification/alteration ' ' 6. DESCRIBE PROJECT BRIEFLY: Initially ~ ~'~O Ultimately 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? NO If NO, describe briefly 9. WHAT IS PRESENT LAr;D USE IN VICINITY OF PROJECT? [] Residential [] Industrial [~"ommercial Describe: [] Agriculture [] Park/Forest/Open space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, on FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATUE O~R~ LOCAL)? ~'Yes [] No If yes, list agency(s) and permit/approvals ~) ¢ ~ ~ C , '. 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ~'~o ~f yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMiT/APPROVAL REQUIRE MODIFICATION? []Yes ~ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE iS TRUE TO THE BEST OF MY KNOWLEDGE Signature: l If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a_~.s, essment OVER 1 PART II--ENVIRONMENT/"~"~SSESSMENT (To be completed by Agen A. DOES ACTION EXCEED ANY I YPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the review process arid use the FULL DAF, [] Yes [] No *" B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 if No, a negative declaration may be superseded by another involved agency. [] Yes [] No COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Ans¥¢ers may be handwritten, tf legible) C1. Existing air quality, surface or'groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly C3. Vegetation or fauna, fish, shellfish or wildlife species, signiticant habitats, or threatened or endangered species? l~xplain briefly: C4. A community's existing plans or goals as officially adopted, or a change in use or ~ntensity of use of land or other natural resources? Ex' C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain bdefty. C$. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly. C7. Other impacts (inclbding changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR iS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL iMPACTS? [] Yes [] No if Yes, explain briefly PART III--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or othen,vJse significant Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of CCC .[~'rjng; (c) duration; (d irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure tha! explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive'declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in.¢&ny significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting tl~is determination: Date 617.21 . S EQ " "' Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM . purpose: The full EAF is designed~to help applicants and agencies determine, in an orderly manner, whether a or action may he significant. The question of whether a~ action may be significant is not always ea'sy to answer. Frequen · ly, there are aspects of a prolect that are subjective or unmeasureable. It is also' understood that those who determin significance may have little or no formal knowledge of the environment or may be technicall~ expert in environment~ analysis. In addition, many who have knowied~,e.in one partidui~,t area may not be aware of the broader concerns affectin the question of significance- EAF s intended toprovide a method whereby app[icants~nd agencies can be assured that the determinat~o The fu . · · *' ...... r process has been orderly, comprehenswe in nature, yet flexible to allow introduction of mformahon to fit a profect or act~o · Full EAF Components: The full EAF is compr'i~ed of three parts: Part 1: Provides'~biective data and ;nformation about'a given prole~t' and its site. By identifying basic proje~ : dat~, it assists a rewewer in the analysis that takes place in Parts 2 znd 3. ~art 2: focuses on identifying the range of possible impacts that may occur from a project or action. It provid~ ~,,uidance as to s~hether an imoact is like'y to be considereo small to moderate or whether it is a ootential[' large ~mpac:. The form. also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whethe;t or not th impact is actually important. DETERMINATION OF SIGNIFICANCE~T~,.pe I and Unlisted Actions Identify the Portions of EAF completed for th~s project: 'j~ Part I ~ Part 2 ~Part 3 Upqn rewew of the information recorded on this EAF [Parts I and 2 and 3 if aDpropriate), and any other supporting infbrmation, and considering both the magitu.de and importance of each impact, it is reasonably determined by rne lead agency that: [] A. The project will ~ot result in any large and important impact(s) and, therefore, is one which will not have a s~gnificant impact on the enwronment, therefore a negative declaration will be prepared. [] B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, , therefore a CONDITIONED negallve declaration will he prepared.* ~] C. The 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 D~claration is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of-Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from responsible officer) Date .' -- ~ PART 1--PROJECT 17' ORMATION Prepared by Project -Sponsor NOTICE: This doc~men~: is designed to assist in determining whether the action proposed may have a significant ef on the environment. Please complete the entire form: Parts A through E, Answers to these questions will be'consid( as part of the application for approva[ and may be subiect to further verifiDadon and oublic review- Provide any additic 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 ~itl not new studies, research or investigation, If ir]formation requiring such additional work is unavailable, so indicate and spe eacN instance. NAME OF AOTION ~ t r. ~ ' ' LOCATION OF ACT, kON 0nciude Street Adch*ess, M~nicipafity at~ci County) CIT'fJPO BUSINESS TELEPHONE STATE' I ZIP CODE NAME OF OWNER (if different} BUSINESS TELEPHONE AOORESS CITY/PO ~iTATE ZIP CODE DESCRIPTION OF: ACTION Please Complete Each Question--Indicate N.A. if not applicable A. Site Description Physical setting of overall project, both developed and undeveloped areas. 1. Present land use: F']Urban r-Ilndustrial .-'l~ommercial FqResidential [suburban) E]Fores£ r'"lAgric ultu re ['"lOther [~Rura] [non-fa~ 2. Total acreage of project area; acres. APPROXIMATE ACREAGE Meadow or Brushland {Non-agricultural) Forested Agricuitura]'~(.Indudes orchards, cropland, pasture, etc.) PRESENTLY AFTER COMPLETION acres 0 acres (~ acres (2~ acres acres O acres acres O acres / acres ~ 4 · ~ acres acres ~ acres acres acres Wetland (Freshwater or tidal as per Articles 24. 25 of ECL) Water Surf.ace Area Unvegetated (Rock, earth or fill) Roads. buildings and other paved surfaces Other (Indicate typeJ 3. What is predominant soil type(s) 6n project site? . a. Soil drainage: ~etl drained ~O % of s~te ~oderately-well drained ~O % o~ site ~Poorly drained ~O-- % o~ s~te b. If any agricultural land is involved, how many acres of soil are classified within soil grouo I through 4 of the N' Land Classification System~O r .acres·(See 1 NYCRR 370]. 4. Are there bedrock outcroppings on pro~ ~Yes ~o a, What is depth to bedrock?~r [in feet} "$'., Approximate ~ercentage or r)ropc pro t~ct ;ite w~th slopes: ' '. - 6. Is projec~ subst~nt[al]v contiguous to, or contain a building, site, or district, ~isted on the S~e or the Nationz ~Yes .' Registers of Historic Places? t-lYes J~o ~". Is project substantially contiguous to a site listed on the Register of National Natura~ Landmarks? 8. What is the .depth of the water table? ,~' ~ [in feet) 9, Is site located over a primary, principal, .or sole source aquifer? I:]Ye~ 10, Do hunting, fishing or shell fishing opportunities presently'~xist in {~e proiect area? I-tYes ,.~o 11. D~es proiect site contain any species of plant or anir~al life that is identified as threatened or endangerec ~Yes ~o According to ~//, _,~ ' " Identify each species 12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formation; I-lYes ,~o Describe 13. Is the proj¢,c= sit-; presently used by the community or neighborhood as an open space or recreation area i-Wes .~o If yes, explain.' · 14. Does the oresen~ site include scenic views known ~o be imoortant ~o the community? OYes 15. S~reams within or conti~uous to prolec~ area: a. Name of Stream.and name o~ River to which it Is tributary a. Name /c,~/~ b. Size (In acres) 17. Is the site served by existing public utilities? ,,~es E3No a} If Yes, does sufficient capacity' exist to allow connection? b] If Yes, will ~mprovements be necessary to allow connection~ t-lYes ,,~o 18. Is the site located 'n an agricultural district ce(tiffed pursuant to Agriculture and Markets Law, Article 2S-AA Section 303 and 3047 FiYes 19. Is the site located in or substantially contiguous to a Critical ~nvironmental Area designated pursuant to Article 8 of the ECL, and 6 NYCRR 6177 F-lYes ,~o 20. Has the site ever been used for the disposal of solid or hazardous wastes? E]Yes ,~o B. Project Description 1. Physical dimensions and scale of project [fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project sponsor b. Project acreage to be developed: ~' "-~ acres, initially; ' · ' c. Project acr?age to ~'emain undeveloped ~" acres. d. Length of project, Jn miles: ~,/ff~F-~ (If appropriate) / acres. acres ultimately. e. If the prelect is an expansion, indicate percent of expansion proposed ~ ' %; t~,~'~'-c~ ~LClC~Ov¥ l, Number of off-street parking spaces existing "9~ ; prOposed ~, g, Maximum.vehicula'r trips llenerated per hour S~upon completion of proiect]? -- h~ Ii residential:' Number and type of housing units: One Family Two Family Multiple Family Condominium Uhimately /~/~ i. Dimensions (in feet) of laq;est p~oposed structure ~/~ height; ; length. j. Linear feet of frontage along a public thoroughfare project will occupy is? ' ft. 2. How much natural_~atenai (i.e., rock, earth, etc,) wilt be re~'~eo from the site? 3. YVil[ disturbed are~, ge reclaimed? ~-es [lNg []N/A ~*~:>~ o~'~*~,~, tons/~Jbic ~arc a. If yes, for what intended purpose is the site being reclaimed? J~V'~"c~',e~ ?c~,C,~ ' .' b. Will topsoil be stockpiled for reclamationS' "~es t-qNo c, Wi I upper subsoil be stockpiled for reclamation? .~es ~No 4. How many acres of vegetation (trees. shrubs, ground covers) will be removed from site? acres. $. Willf_lYesany matu(e~,No~fOrest (over. . 100 years old) or other locally-important vegetation be removed b~ this project? 6. If single phase project: Anticipated period of construction ~ months. [including ~emofition]. 7. If mu]ti-phased: a. Total numaer of phases anticipated bet). b. Anticipated date of commencement phase 1 ~ mon th year, (including demolition c. Approximate comp etlon date of final phase __ ph~a month year. d. Is phase I functiona ly dependent on subsequent ? ~Yes r~No 8. Will blas'~ing occur during construction? ' ~Yes 9. Number of iobs generated: during construction . ,~:'~; after project is comoiete .. 10. Numaer of iobs eliminated by ibis proiect C~ . 11. Will proiect reqmre relocation of any projects or facilities~ ' [~Yes ~o If yes, e×p[ain 12. Is surface liquid waste disposal involved? f-lYes a. If yes, indicate type of waste [sewage, industrial, etc.) and amount --~ b. Name of water body into which effluent will be discharg~.d ~ 13. Is subsurface liquid waste disposal, involved? [Yes ~1~o Type 14. Will surface area o~f an existing,~ater body [~crease or decrease by oroposal2 .~es 15. Is project or any portio(n of project Ioca'ted in a 100 year flood Plain? UYes t~No 16. Will the project generate solid waste? []Yes a. If yes, what is the amoun~ per month ~ tons b. If yes, will an existing solid waste f~ ~u/~sed? l-lYes [~No d. Will any wastes not go in~o/.sewage dis~'osal system or into a sanitary landfiH~ i--lYes lqNo e. If Yes, explain ' 17. Will the project involve the disposal of solid waste? E3Yes ~0 a. If yes, what is the anticipated-rate of disposal? tons/month. b. If '/es, what i~ the anticinated site life? -- '/ears· 18. Will project ~se herbicides or pesticides? - ~Yes 19. Will proiect routinely produce odors ('more than one hour per day)? ~lYes ~o 20. Will project produce operating noise exceeding the local .ambient noise evels~ ~]Yes 21. Will project result in an 'ncrease 'n energy use? [~]Yes ~o If yes , indicate type(s) 22. If wa£er supply zs from wells, indicate pumping capacity ~, OQO ~c_ gallons/minute 23. Total a~tlc~pated wamr usage per day ~,d_. - gallons/day. 24. goes prolect involve Local. State or Federal funding? J~Yes If Yes, explain Sul~mitta[ Date ~25. Approvals Required: City, Town, Village Board' fi-lyes City,.Towq, Village Planning Board ~es E~No City, Town Zoning Board - [~Yes ~o City, County Health Department l-lyes . Other Local Agencies .~ff'es '~No Other Regional Agencies F-Iyds ~NQ State Agencies ~'es "[~No Federal Agencies ~[~'Yes I-1No C. Zoning and Planning Information 1. Does proposed ac'dion ~nvoive a.planning or zoqing decision~ ClYes ' .~o If Yes, indicate decision required: J-lzoning amendment I-Izoning variance r-lspecial use~ riP'mit div?ion [~new/revision of master plan. ~resource manage/0~'~ plan F'ld'th, dr~'~ 2. What is the zoning cJassificati~n(s)of the site? 3. What is the maximum potential development of the site if d~ve[oped as permi.tted 4. What is the proposed zoni:g of the site? \~'N ."t~. ._ 5. What is the maximum potential development of the site if dev~looed as permitted [~]site plan bv the present zoning? by the proposed zoning? 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? '~es -[],~ 7. What are the predomi-~ant land use(s) and zomng classifications within a 'A mite radius ot proposed action? 8. [s the proposed action compatible with adjoining/surrounding land uses within a ~A mi{e? ~Yes 9. [f proposed action is the subdivision of land, how many lots are proposed? the a. What is the mimmum lot size proposed? 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? I--lYes 11. Will the proposed action create a demand for any community provided services [recreation. education, po[ic fire protection)? I-lYes ~ ,~ _ a. f yes, is existing capacity 'sufficien~ to handle projected demand? E3Yes~///,~o 12. ',Viii the pro~:~,osed action result in the generation of traffic significandv above present levels? >,l-lYes a. If yes, is the existing road network adequate tq handle the additional traffic? I"IYI~//~,I-'iNo D. Informational Details Attach any additional [nfcrmation as mav be needed to clarify your project. If there are or may b~ any adver! impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate avoid them. C E. Verification I certify that the infc)rmation provkted above is true to the host of my knowledge. ~/~ wilh this ~Ssessmenl. 5 P~rt 2--PROJECT IMPACTS A'~-~) , - - ,' " THEIR MAGNITUDE ...... Responsibilil¥ of Le;,,~ Agency General Information ('Read CarefuJly) · In completing the forn; the reviewer should he guided by the question: Have my responses and determinations reasonable.~ The reviewer is not expected to be an expert environmental analyst. . · Identifying that an impact will be potentially large (column 2] does not mean that it is-also necessarily sig~iflcz asksAny largethat itimpaCtbe lookedmUstatbefurther.eValuated in PART 3 to determine significance. Identifying an impact in column 2 sir · The Examples provided are to assist the reviewer by showing types of impacts and Wherever possible the threshol magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State for most situations. But, for any specific project or·site other examples and/or lower thresholds may be appropr for a Potential Large Impact response, thus requiring evaluation in Part 3 · The impacts of each project, on each site, in each loca ity, will vary. Therefore. the examples a~:e' illustrative have oeen offered as guii:lance. They do not.constitute an exhaustive list of im pacts and thresholds to answer each quest · The number of examples per question does not indicate the importan~:e 0f each question. · In identifying Jmpa~:'ts, consider long term, short term and cumlative effects. Instruclions (Read carefully) 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 -t~]en check the appropriate box .(column q or 2] to indicate the potential size of impact. If impact threshold equals or exceeds any example provided, check column 2. If impact witl occur rout thresh~ is load, er than example, check column 1. ' d. If reviewer has doubt about size of the impact then consider the impact as potenually large 'and' proceed to PART e. If a potentially large impact checked in column 2 can be mitrgated by chance(s] in the mro]ect to a smaN t~ moder; impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible· must be explained in Part 3. IMPACT ON LAND' . 1. WiN the proposed action result in a physical change to the Droiect site? EXamples that would apply to cblumn 2 ~NO ~YE5 · Any Construction on slopes of 15% or greater, (15 foot rise per 100 foot of length), or where the general slopes in the proiect area exceed 10%. ~3C°nstructi°n[eet, on land where the depth to the water table [s less than · Construction of pa,~ed parking area for 1,000 or more vehicles. · Construction on land'where bedrock is exposed or generally within 3 feet of existing ~round surface. · Construction that will continue for more than 1 year or involve more than one phase or stage. · £xcavation for mining purposes t~a[ would remove more than ~,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 there be an effect t: .... ,y ur~,que or unusual land forms found rm the Site? (i.e., cliffs, dunes, geological formations, etc.)[~NO · Specific land forms: Small to Potential Moderate ~ Large __ impact Impact 3 Can Impact B.~ Mitigated By Project Chart9 []]Yes' F-1No I~Yes I']No [~]Yes [~Yes ~]No I~Yes [~No [~]Yes [~]No [:]Yes [=]No ~Yes ~No IZJyes IZJNo [~Yes E]No .. IMPACT ON WATER ·. 3. Will proposed action affect any water body designa~e.d as protected? ~' (Under Articles 15, 24, 25 of the Environmental Conservati0h Law. ECL) " ~]NO E3YES Examples that would apply to column 2 ·Deveicpable area of site contains a protected water body. · Dredging more than 100 cubic yards of material from channel of a protected stream· ' · Ex{ension of utility distribution facilities through a I~rotected water body. · Construction in a designated freshwater or tidal wetland. o Other impacts: 4. Will proposed action affect any non-protected _existing or new body of water? E]NO E]YES Examples that would apply to column 2 · A 10% increase or decrease n 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? []NO FqYES Examples that would apply to column 2 · Proposed Action will feature a discharge pertain · Proposed Action requires use of a source of water that does have approval to serve proposed (project) action.. · Proposed Action requires water supply from wells with greater than 45 gallons oer minute pumping capacity. · Construction or operation cnusing any contamination of a water supply system. · Proposed Action will adversely affect groundwater. · Liquid effluent will be conve?ed off the site to facilities which presently ~'do not exist or have inadequate capacity. ,· Proposed Action would use water in excess of 20,000 gallons per day. · Proposed Action wi[I likely cause siltation or other discharge into an existing body of wa~er to the exte?.t that there wilt be an obvious visual contrast to natur~i conditions. · Preposed Action will require the storage of petroleum or chemical -'products greate? than 1,100 gallons. · Proposed Action will allow residential uses tn areas without water and/or sewer services. · Proposed ACtmn locates commercial and/or industrial uses which may require new or expansion of existing waste treatmen't and/or storage facilities. · Other impacts:i' L 6 · Will proposed action alt~r drainage flow or patterns, or surface water runoff? E]NO [-]YES Examples that would apply to column 2 Proposed Action would change flood water flows. 7 ~ 2 3 Small.to Potential Gan Impact B Model:ate 'Large '~ Mitigated By Impact Impact Project Ghanc_ [] [] []Yes' I-'~ N ~ [] '[] r-lYes E~N~ [] [] f--lYes U ~ ~Yes UNo ~ ~ ~Yes ~ ~ ~Y'es ~ ~ ~Yes ~Nc ~ ~ ~Yes ~Nc ~ ~ ~Yes I~NC ~ D ~Yes ~NC ~ ~ ~Yes ~Nc ~ ~ . ~Yes ~Nc ~ [] ~Yes ~ ~ ~Yes QNo ProPosed Action. may cause substantial erosion. " PropoSed Action is incompatible with existing drainage patterns. Proposed Action will allow development in a designated floodwa,y. Other impacts: IMPAOT ON AIR 7. Will proposed action affect air quality? F'3NO l-lYES Examples that Would apply ~:o-~olumn 2 .. · Proposed Action will induce 1,000 or more vehicle trips in any given hour. .' · Proposed Action will r~;~ult in the incineration of more than 1 ton'of refuse per ;]our. · Emission rate of total contaminants will exceed 5 lbs. per hour or a heat source producing more than 10 millipn' BTU's per hour· · Proposed action will allow an increase in the amour;t of land committed to industrial use. · Proposed action will allow an increase [n the dens(ty of industrial development within existing industrial areas. · Othe~ impacts: IMPACT ON' PLANTS AND ANIMALS ~. Will Proposgd Action affect any threatened or endangered ~pecies? . [~NO I-iY ES 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: . Will Proposed Action substantially affect non-threatened or non-endangered species? .' .. I-]NO E3YES Examples that would appi'/ to column 2 " - Proposed Action would substantially interfere with any resident of migratory fish, shellfish or wildlife species. Proposed Action requires the removal of' more than 10 acres of mature [orest (over 100 years of a~e} or other locally impo£tant vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES Will ;he Proposed Action affect aSncultural land resources? C~NO I~Y~S Examples Ihat would apply to column 2 the prOposecl actmn would sever, cross or limit access to asr}cultural .,nd {includes c~opland, hayfields, pasture, vineyard, orchard, etc.) Small to Moderate Imp&ct 2 Potential '" Large Impact Mitigated 13y I Project Chang,e,] ( OYes [~No i: r No i-]Yes [] NO' [~Yes I-}No []Yes [-']Yes [~Yes ~Yes []Yes []Yes E~Y~s [] Yes [~Yes [~]Yes ~Yes [-]No r-tNo E~No []No []No r-INo E~No [~]No Consiruction activity would excavate or compact the soil profile of agricultural land· . The proposed action would irreversiblY convert more than'10 acres of agricultural land or, if located in .an Agricul?utal District, more theft 2.5 acres of agricultural land. The proposed action would disrupt or prevent installation of agricultural land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runcJff) Other impacts; IMPACT ON AESTHETIC RESC~URCES 11. Will proposed action affect aesthetic resources? L-1NO []YES (If necessary, use the Visual EAF Addendum in Section 61.7.21, Appendix B,) Examples that would apply, to column 2. · Proposed land uses, or project components obviously different from or in sharp contrast to current surrounding land use patterns, whether man-made or natural. · Proposed land uses, or projec~ components visible to users of aestheuc resources which will eliminate or significantly reduce their enlovment of the aesthetic qualities· of that resource· Proiect components that will result in the eliminatmn or significant screemng of scenic views known to be imoortant 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? L-]NO Il-lyES Examples that would apply to column 2 · Proposed Action occurring wholly or partially within or substantially conti~uous to any facility or site listed on the State or National Register of historic places. Any impact to all archaeological site or fossil bed ocated within the project site, Proposed Action will occur in an area designated as sensitive for archaeological sites on the NYS Site lnven:ory. Other impacts: L IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the qu,mt~ty or quality oJ existing or future open spaces or recreational opportunities~ Examples that would apply to Column 2 C]NO ~YES · The permanenl foreclosure of a future recreational opportumtv. · A major reduc[mn of an open space important to the commumJy. · Olher impacts: Small't'o Pdtentia~' Can Impact B~ Moderate Large Mitigated By Impact Impact Project Chang,, · [] 'F-] ' J-'lYes [~No [] [] I--lYes' [~]No [] [] []Yes' I~']No [] [] ~ ~Yes . [~]No [:] []' ~Ves J~N0 [] [] r-lyes E]No . [] [] r-tves ~-lNo [] [] l-lyes i--INo [] [] []Yes r-lNo [] [] []Yes []~o' [] [] []Y,s' []No /'q [] []','es []~o [] [] I-IYes []mo [] E] /'qYes r/No II~IPACT [ TRANSPORTATION 14. Will there be an effect to e..xisting transportation s'/stems? []NO []YES Examples that would apply to column 2 · Alteratio~ of present patterns of movement of people and/or goods. .e Proposed Action will result in major traffic problems. ,, Other impacts: IMPACT ON ENERGY 15. Wilt proposed action affect the communit~,'s sources c;f fuel or energy supply? .- [~]NO EaYE$ Examples that would apply to column 2 · Proposed Action will cause.a greater than 5% .increase in the use of any form of energy in.the municipality. ' · Pre;osed Action will requite the creation or extension of an energy transmission or supply system to serve more than 50 single or two family residences or to serve a malor commercial or industrial use. · Other impacts: NOISE AND ODOR IMPACTS Will there be objectionable odors, noise, or vibration as a result of the Proposed Action? ~NO []YES Examples that would apply to column 2 · Bias:in8 within 1,500 feet of a hospital, school or other sensitive facdity. "Odors will occur routinely (more.- than one hour per day). · Proposed Action will produce operating noise exc~edin8 the local ambient noise levels for noise outside of structures. ~ Progosed Action will remove natural barriers that would act as a noise screen. ' Other impacts: , IMPACT ON PUBLIC HEALTH 7. Will Proposed Action affect public health and safety? [aNO ~YE$ Examples that would apply to column 2 Proposed Action may cause a risk of explosion or reiease 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 "hazardous Wastes" in any. form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etC.) Stota[;e fatalities for one million or more L~aJlo~s of liquified natural ~[as or odmr flammable liquids. .' Proposed action may result in the excavation or other distud)ance ,vltlun 2.000 f~-'et of a site used for the disposal of solid or hazardous ,va~, Odmr impacts: 10 1 Small to Moderate Impact 2 Potential Large impact Can Impact"B~e ' Mitigated By J Project Chang~ ~.- [] E]¥es [] [~Yes [] E3¥es E~No ~No [] I-'tYes ~No [~Yes [~Yes t-}No ['"]Yes J-'~NO J~]Yes I-]No J-]Yes J~No I--]No l-qNo E]Yes ['-]No J~Yes [-']No J~Yes [~No C]Yes [~]Yes ElNa IMPACT ON GROWTH AND CHARACTER OF COMMUNITY OR NEIGHBORHOOD 18. Will proposed action affect the character of the existing commumtv? (~'. ' E3NO E3YES Examples 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 · The mumcipal budget for capital expenditures or operatm~ services will increase by more than'5% per year as a result of'this pro ect. · Prooosed action will conflict with officially adopted plans or goals. · Proposed action will cause a change in the density o~ land use. · Proposed Action will replace or eliminate existing facilities, structures or areas of historic importance to the community. · Development will create a demand'for additional community services (e.g. schools, police and fire, etc.) · Proposed Action will set an important precedent for future prolects. · Proposed Action will create or eliminate emolovment. · Other impacts: I 2 3 Small'lo Potential,' Can Impact Moderate Large Mitigated By Impact Impact Project g;~ang~ [] [] E~]Yes .. i-3No [] [] I']Yes E]No [] [] E]Yes" [] ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~ .. ~ . ~Yes ~No ~ ~ ~Yes ~No '~9. Is there, or is there likely to be. public controversy related to .- potential adverse environmenta impacts? [~]NO ~'YES If Any Action in Part 2 Is Identified as a Potential Large lmaact or If You Cannot Determine the Magnitude of Impact. Proceed to Part 3 Part 3--EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibilily of Lead Agency Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if lhe impactCs) may b mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: 1. Briefly describe the impact. 2, Describe Iif april}cable) 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 f it is reasorih ~le to conclude that tl~is impact is important. To answer the question of importance, consider: · The probability of the impact occurring · The duration of the ~mpact · Its irreversibility, including permanently lost resources of value · Whether the impact can or will be controlled · The regional consequence of the impact · Its potential divergence from local needs and goals · Whether known objections to the project relate to this impact (Continue on attachmentsl 11 SEQR ,( (_ 617.21 ' Appendix B .-. Slate Environmental Quality Review Visual EAF Addendum This form may be used to provide additional information relating to Question 1 l'of Part 2 of the Full EAF. (To be completed by Lead Agency) Visibitii:y 1. Would the project be visible from: · A parcel of land which is dedicated to and available to the public for the use. enjoymen~ and appreciation of natural 'or man-made scenic qualities? · An overlook or parcel of land dedicated to public observation, 'enjoyment and appreciation of'natural or man-made scenic qualities? · A site or structure li~ted on the National or State Registers of Historic Places? · State Parks? · The State Forest Preserve? · National Wildlife Refuges and state game refuges? · National NaturAl Landmarks and other outstanding natural features? · National Park Service lands? · Rivers designated as National 6r State Wild, Scenic or Recreational? · Any transportation .corridor of high exposure, such as part of the Interstate System. or Amtrak? · A governmentally established or designated interstate or inter-county foot trai . or one formally proposed for establishment or designation? · A site. area, lake. reservoir or highway designated as scenic? · Municipal park, or designated open space? · County road? · State? · Local road? Distance Between Project and Resource (in Miles) 0-'/~ ,~.I/2 '/2.3 3-5 5+ [] 0. [] [] [] [] [] [] [] [] [] [] [] [] [] F' [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] F- [] [] Is the visibiUty of the project seasonal? (i.e., screen'ed by summer foliage, but visible during other .seasons) []Yes []No 3. Are any of the resources checked in question 1 used by the public during the time of year during which the project will be visible? []Yes ElM• DESCRIPTI( OF EXISTING VISUAL ENVIRONME. . 4.enviroriment.Fr°m each i.tem checked in question 1, check those which generally describe the Essentially undeveloped Forested Agricultural Suburban residential Industria I Commercial Urban River, Lake, Pond Cliffs, Overlooks Designated Open Space Flat Hilly Mountainous Other NOTE: add attachments as needed 5. Are there visually similar pro.iects within: 'V2 mile [~Yes *! miles '2 mites E~Yes [~]No '3 miles · [~'~es [~No Wit bin 'I/4 mile. ,, [] [] surro~n;ding ! mile ' Distance from project site arie provided for assistance. Substitute other distances as appropriate. EXPOSURE 6. The annual number bf viewers likely to observe the proposed project is NOTE: When user data is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity in which the viewers are engaged while viewing the proposed action is FREQUENCY Activity -~ Travel to and from work Involved in recreational activities Routine travel by residents At a residence At worksite Other Holidays/ Daily Weekly Week ends Seasonally Boa/ of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE IS THE~PPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEFs AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I PLEREB¥~ AUTHORIZE THE TRUSTEES, THEIR AGENT,S) OR REPRESENTATIVEs(s), TO ENTER ONTO MY~PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. / ~n~tur e~ SWORN TO 'BEFORE ME THIS Notary Public k~mr/P~:, SI~ ot N~ Yo~ No. 3O-4741154 in Nass= ISulfol~un~ ~-' 3 Boa~ ~ of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity~ ~~ ~c~e_ ~ Are wetlands present within 75 feet of the proposed activity? ~ No Yes Does the project involv~excavation~n~r ~illing? No ~/ Yes If Yes, how much material will be excavated? ~ How much material will be filled? ~ Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) ( cubic yards (cubic yards