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Home My WebLink AboutSilverman, Henry B.Albert J. Krupski, President John Holzapfel, Vice President William G. Albertson Martin It. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 April 6, 1994 Mr. Henry Silverman 583A Sound Shore Road Riverhead, NY 11901 Re: SCTM #56-6-10 Dear Mr. Silverman, After a review of your file in our office, the Board feels it impossible to make an accurate determination of your project. It appears from the Peconic Surveyors survey, April 18, 1989, that the entirety of your parcel is intertidal wetlands. Questions of how access could be obtained to the upland and who the adjacent property owner is remain. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh TRUSTEES John M. Bredemeyer, III, President Henry P. Smith, Vice President Albert J. Krupski, Jr. John L. Bednoski, .Tr. John B. Tuthi[l 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 October 3, 1991 Henry Silverman 583 A. Sound Shore Road Riverhead, NY 11901 RE: SCTM #1000-56-6-10 Dear Mr. Silverman: Pursuant to our field inspection of 9-26-91, the $outhold Town Trustees would have no objection to a limited'boat docking facility for your proposed site at Mill Creek, Southold of no more than three boats, provided adequate parking permissions are granted by the NYSDOT and your project is reviewed by the Town Planning Board. The Trustees will require you to submit an application for a Town Wetlands permit when you have finalized Four plans for this project after talking with other involved agegcies. If we may be of further assistance, please do not hesitate to contact this office. Very truly yours, John M. Bredemeyer, III President, Board of Trustees JMB: jmt cc: Planning Board CAC NYSDOT 765-1801 TOWN OF SOUTHOLD OPEN SPACE COMMITTEE Town Hall ...... --~-~ ~ Southold, ~. F~.. ~ ~ ~~ ~ I~ II \q L~ nl OF SOUI'HOLD February 1, 1991 Henry Silverman 583 A. Sound Shore Rd. Riverhead, NY 11901 Dear Mr. Silverman: Thank you for your interest in the Open Space Program. Please complete the enclosed form and return it to the address listed on it. The committee will be glad to review your property. FAR:jw Enclosure Very truly yours, Frederick A. Ross, Chairman Southold Open Space Committee cc - Town Trustees TRUSTEES John M. Bredemeyer. III. President Henry P. Smith. Vice President Albert .I. Krupski. Jr. John L. Bednoski. Jr. John B. Tuthill Telephone ~516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTT L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold. New York 11971 Fax 1516l 765-1823 Telephone (516) 765-1800 TO: FROM: RE: DATE: Harvey Arnoff, Town Attorney John M. Bredemeyer, III, President Henry Silverman - Dock Application January 29, 1991 Enclosed please find the memo of May 2, 1990 asking for a response with regard to the zoning matter in the above referenced project. Please respond as soon as possible as this project has not gone forward since May. Thank you. TRUSTEES John M, Bredemeyer, III, President Henry P. Smith, Vice President Alber~ J. Krupski, Jr. John L. Bednoski. Jr. John B. Tuthill Telephone (516) 765.1892 BOAR~ OF TOWN TRUSTEES TOWN OF SOU~OLD SCOTF L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 May 2, 1990 TO: FROM: RE: Harvey Arnoff, Town Attorney M. Bredemeyer, III, President John Henry Silverman / Dock Application Recently the Trustees received a catwalk, ramp, and float application (basic dock) by an individual who wishes to place same for personal use on C-Zone commercial property he owns. May we issue a dock permit for his personal use on commercial property without special conditions or ~lanning Board review? Please respond as soon as possible. Thank you. TRUSTEES John M. Bredemeyer, III. President Henry P. Smith. Vice President Albert J. Krupski. Jr. John L. Bednoski, Jr. John B. Tuthill Telephone 1516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOa~I' L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 TO: FROM: RE: Joyce Wilkins, Secretary to Open Space Committee Jill Thorp, Secretary to Board of Trustees~/~ Property of Henry Silverman SCTM #1000-56-6-10.1 DATE: January 29, 1991 I have received an inquiry from Mr. silverman asking if the Town would be interested in buying his piece of property located West of Mill Creek on the south side of Route 25. If the Open Space Committee wishes to contact. Mr. Silverman, you can reach him at 583 A. Sound Shore Road, Riverhead, NY 11901. 722-8188. cc: Henry Silverman Trustees , P,.~ CUFF 3 3 8 HENRY I~. SILVERMAN ,?~. GAlL E. SILVERMAN TRUSTEES John M. Bredemeyer, Ill. President Henry P. Smith, Vice President Albert J. Krupski. Jr. John L. Bednoski, Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SCOTt L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 May 2, 1990 TO: FROM: RE: Harvey Arnoff, Town Attorney John M. Bredemeyer, III, President~'~ Henry Silverman / Dock Application Recently the Trustees received a catwalk, ramp, and float application (basic dock) by an individual who wishes to place same for personal use on C-Zone commercial property he owns. May we issue a dock permit for his personal use on commercial property without special conditions or Planning Board review? Please respond as soon as possible. Thank you. TRUSTEES John M. Bredemeyer, II1, President Henry P. Smith, Vice President Albert J. Kmpski. Jr. John L. Bednoski. Jr. John B. Tuthill Telephone (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD scoTr L. HARRIS Supervisor Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 March 26, 1990 Mr. Henry Silverman 583A Sound Shore Road Riverhead, NY 11901 RE: Application 1-2-89-56-6-10 Dear Mr. Silverman: The following action was taken by the Board of Town Trustees at its regular meeting held on March 22, 1990: Resolved that the above-referenced application be tabled until the Town Attorney reviews it and presents his comments and recommendations to the Trustees. Should you have any questions, please feel free to contact this office. Sincerely, ../~ohn M. Bredemeyer, III /~ ~President, Board of True,fees - JMB: jb cc: CAC File GAlL & HENRY SILVERMAN 583A Sound Shore Rd. Riverhead, NY 11901 (516) 722-8188 Board of Town Trustees Town of $outhold Town Hall, 53095 Main Road P.O. Box 728 Southold, N.Y. 11971 February 20,1990 Dear Mr. John Breadmire; As per our phone conversation on February 14,1990. En- closed find the copy of my check paid to the Trustees on 1/3/ 89 for $150. I would like to dock my 32 foot boat on my land this coming boating season. Could we please resume the process of approving this appli- cation. I could have land and creek flagged for you at any time you wish for your inspection. nryank you, B. $ilverman Z Pine Cliff 9464' Purpose: Boat Dock Datum: Mean Sea Level Adiacent Property Owners: 1. N.Y.S. Rt. 25 to the North 2. Lewis Homos Co to the South Proposed Dock In Mill Creek At A~shamomaque County el Suffolk State New York Application by Henry Silverman 583A Sound Shore Rd. Rivemeed, NY 11901 Application #89-0037-12 Sheet ! ol 1 Data 9/19/89 BRIDG Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 TELEPHONE (516) 765-1938 PLANNING BOARD OFFICE TOWN OF SOUTHOLD October 6, 1989 Mr. Henry Silverman 583A Sound Shore Road Riverhead, New York 11971 Re: Proposed Site Plan for Pine Cliff Docking Site Southold, New York SCTM # 1000-056-06-10. Dear Mr. Silverman, The Planning Board has reviewed the revised site plans that were received on September 19th. The application remains incomplete, as per this Board's letter of May 2, 1989. A copy of same is enclosed for your reference. Before the Planning Board can proceed, the following items must be addressed: 1. The long Environmental Assessment form must be completed and returned. 2. The additional fee that was requested in the April 17, 1989 letter has not been submitted. 3. Indicate whether dredging will be required at the docking site. The parking that is shown on the site plan is on New York State property. Parking within a right-of-way cannot be approved by this Board. Upon receipt of twelve (12) copies of a revised site plan, the.additional fee, the dredging information and the long environmental assessment form, the Planning Board will be able to proceed with reviewing your application. At present, the application is incomplete and cannot be reviewed. If you have any questions, please do not hesitate to contact this office. Very Truly Yours, CC: Victor Lessard, Principal Building Inspector Frank A. Kujawski, Jr., President, Trustees James A. Schondebare, Town Attorney /own Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 TELEPHONE ($16) 765-1938 PLANN~qG BOARD OFFICE TOWN OF SOUTHOLD May 2, 1989 Henry Silverman 585 A Sound Shor~ Road Riverhead, New York 11901 RE: Proposed Site Plan for Pine Cliff Marina SCTM ~1000-56-6-10 Dear Mr. Silverman: The Planning Board has reviewed your application, but is unable to proceed further because the site plan is not complete. The following items are missing: Site plan elements as required by Section 100-255 of the Zoning Code. Long Environmental Assessment Form (A copy is enclosed for your convenience). Show required parking as per zoning code (Section 100-191) proposed number of boat slips. Indicate whether dredging will be necessary, and, if so, how much. Upon receipt of revised site plans, the completed Long Environmental Assessment Form and the additional fee as per this office's letter of April 17th, the Planning Board will proceed with its review. If you have any questions, please do not hesitate to contact this office. cc: Trustees Board Victor Lessard, Building Dept. VS/jt FRANK A. KUJAWSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-President JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. HENRY P. SMITH TELEPHONE (516) 765-1892 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 March 1, 1989 Henry Silverman 583A Sound Shore Road Riverhead, N.Y. 11901 Re: Wetland application number 1-2-89-56-6-10, walkway and floating dock for 5 boats. Dear Mr. Silverman: Please be advised that the Trustees have inspected above mentioned property on January 19, 1989 and have determined that site plan approval by the Planning Board and Zoning Board of Appeals will be necessary before further processing of application can be done by the Board of Trustees. cc: Planning Board Z.B.A. Very truly yours, Frank A. Kujawski, Jr./d President %~ / Board of Trustees ~' FAK:jas TO: FROM: DATE: RE: Robert H. Berntsson, Assistant Town Attorney Frank Kujawski,Jr. Pres. Bd. of Trustees January 20, 1989 Wetland Application of Henry Silverman As per the Trustees site inspection of January 19, 1989, the concern of this Board is the possibility of this project being a mini marina. Would you please review the code and advise us as to the following questions: 1. Under the Southold Town Code, how much control would the Trustees have over this project? 2. Would there be any restrictions as to size of boats using this dockage? We will appreciate your advice on this matter. FRANK A. KUJAgrSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-President JOHN M. BREDEMEYER, III JOHN L. BEDNOSKI, JR. HENRY P. SMITH TELEPHONE (516~ 765-1892 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD Town Hall, $3095 Main Road P.O. Box 728 Southold, New York 11971 March 1, 1989 Henry Silverman 583A Sound Shore Road Riverhead, N.Y. 11901 Re: Wetland application number 1-2-89-56-6-10, walkway and floating dock for 5 boats. Dear Mr. Silverman: Please be advised that the Trustees have inspected above mentioned property on January 19, 1989 and have determined that site plan approval by the Planning Board and Zoning Board of Appeals will be necessary before further processing of application can be done by the Board of Trustees. cc: Planning Board Z.BoA. Very truly yours, President Board of Trustees FAK: j as FRANK A. KUJAWSKI, JR., President ALBERT J. KRUPSKI, JR., Vice-President JOHN M. BREDEMEYER, 1II JOHN L. BEDNOSKI, JR. HENRY P. SMITH BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 SouthoId, New York ! 197! TO: FROM: DATE: RE: Robert H. Berntsson, Assistant Town Attorney Frank Kujawski,Jr. Pres. Bd. of Trustees January 20, 1989 Wetland Application of Henry Silverman TELEPHONE (5161 765-1892 As per the Trustees site inspection of January 19, 1989, the concern of this Board is the possibility of ~his project being a mini marina. Would you please review the code and advise us as to the following questions: 1. Under the Southold Town Code, how much control would the Trustees have over this project? 2. Would there be any restrictions as to size of boats using this dockage? We will appreciate your advice on this matter. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE 765-1892 APPL I CAT DENT I TY TAX MA~ N · I , AVERAGE RISE IN TIDE AREA FT. MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED INTENDED USE OF PROPERTY__ ---- ~ DESCRI BE ANY KNOWN PRIOR OI~ERATIONS CONDUCTED ON AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID P~MISES AND WHETHER ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENTAL DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE PREMISES AFTER THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF THE PROJECT SITE IF NECESSARY WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF NOT THE SAME AS THE AR~LICANT._ .......... j~_, ARE THERE ANY COVENANTS QR RESTRICTIONS IN YOUR DEED THAT WOULD PROHIBIT THIS PROJECT? /~/O PR'OJECT I.D. NUMBER PART I--PROJECT 1. APPLICANT ISPONS 4. PRECISE LOCATION 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only ~ORMATION (To be cor{,pleted by Applicant or Project sponsor) r~t:~esyt d'~ad ',~ers~ct °rs' pr°rrine-r~$',~ /~ ..'3-~9~-'~..~ etc., or provide map, SEQR 5. IS PROPOSED ACTIr; .~New E ~bansion 6. DESCRIBE PROJEC~ :UEFLY: [] Modification/alteration 7. AMOUNT OF LAND Initially 7~ 8. WILL PROPOSED A .:ECT~: If NO. describe briefly g. WHAT IS PRESENT [~ Residential Describe: ;D UG~ IN VICINITY OF PROJECT? ~ Industrial [;~kr Commercial [] Agriculture []Park/Forest/Open space [~Other 10. DOES ACTION INV' STATE OR LOCAL [~'Yes 11. DOES ANY ASPE ~Y~ ~ JE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, NO I! yes, llst agency(s) and permitlepprovals OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? If yes, list agency name and permit/aporoval )POSED ACTION WILL EXIST NG PERMIT/APPROVAL REQUIRE MODIFICATIONq 3ERTIFY THAT THE INFORMATION PROVIDED OVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the Coastal Area, and yeu are a state agency, complete the Coastal Assessment Form before proceeding with this a~sessment OVER 1 PART II-- ENVIR /IENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION EX(~EED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinale the rewew process and use the FULL E',A.F. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explairt briefly; C3. Vegetation or fauna, fish, shellfish or wildlife species, signdicant habitats, or threatened or endangered species? Explain briefly: C4. A cornmunity's existing plans or goals as officially adopted, or a change in use or Intensity of use of land or other natural resources? Explatn briefly. C5. Growth, subseguenl development, or related activities likely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in CI-C57 Explain briefly. C?. Other impacts (including changes in use et 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 Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIO~I:~: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. ~Jrban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f} magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified'and adequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result Jn any significant adverse environmental impacts AND provide on attachments as necessary, the reason, s supporting this determination: . .14.16-,2 (2/87)--7c Purpose: The full or action may be sigm Iy, there are aspects significance may haw analysis. In addition, the question of signif The full EAF is in process has been order Full EAF Components Part 1: Provid, data. i' Part 2: Focuse guidan large i~ Part 3: If any impaci 617.21 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM SEQR designed to help applicants and agencies determine, in an orderly manner, whether a project ,tnt. The question of whether an action may be significant is not always easy to answer· Frequent- :. project that are subjective or unmeasureable. It is also understood that those who determine ttle or no formal knowledge of the environment or may be technically e_xpert in environmental -y who have knowledge in one particular area may not be aware of the broader concerns affecting ,ded to provide a method whereby applicants and agencies can be assured that the determination comprehensive in nature, yet flexible to allow introduction of information to fit a project or action. 'he full EAF is comprised of three parts: objective data and information about a given project and its site. By identifying basic project ~,sists a reviewer in the analysis that takes place in Parts 2 an~J 3. m identifying the range of possible impacts that may occur from a project or action. It provides as to whether an impact is likely to be considered small to moderate or whether it is a potentially- ,act. The form also identifies whether an impact can be mitigated or reduced. pact in Part 2 is id(;ntified as potentially-large, then Part 3 is used to evaluate whether or not the actually important. D[ Identify the Portio Upon review of th~ information, and c lead agency that: [] A The p have ~ [] B. AlthoL effect theref [] C. The p~ on th~ · A Condition =_RMINATION OF SIGNIFICANCE--Type I and Unlisted Actions of EAF completed for this project: [] Part1 [] Part 2 ' []Part 3 fformation recorded on this EAF (Parts 1 and 2 and 3 if appropriatel, and any other supporting sidering both the magitude and importance of each impact, it is reasonably determined by the ~ct will not result in any large and important impact(s) and, therefore, is one which will not ignificant impact on the environment, therefore a negative declaration will be prepared. the project could have a significant effect on the environment, there will not be a significant this Unlisted Action because the mitigation measures described in PART 3 have been required, a CONDITIONED negative declaration will be prepared.* ~'ct may result in one or more large and important impacts that may have a significant impact nvironment, therefore a positive declaration will be prepared. '~_ Negative Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Yype Name Responsible Officer m Lead Agency Title of Re*pons~ble Officer Signature of R( ons~ble Officer in Lead Agency Signature of Preparer(If different from responsibleofficerl Date 1 PART 1--PROJECT INFORMATION · Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effe, on the environment. Please complete the entire form, Parts A thro[~gh E. Answers to these questions will be considere as part of the application for approval and may be subject to further verification and public review. Provide any additiom 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 invoJv new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specif each instance. NAME OF ACTION N'AME OF OWNER (if different) ADDRESS and County) / STATE ZIP CODE I~USIN ESS TELEPHONE ( CITY/PO I STATE ( ZIP CODE 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: []UrbaR ~llndustrial ~Commercial [~Residential (suburban) [~Rural (non-farm [~Forest I~Agriculture ~]Other APPROXIMATE ^CREAGE -- /(~ PRESENTLY AFTER COMPLETION Meadow or Brushland {NomagriculturaJ) acre~ acres Forested acres acres AgrictdturaJ {Includes orchards, cropland, pasture, etc ) J~ .,,~acres . -.~¢'acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) -,,'~/ Water Surface Area acres acres Unvegetated (Rock, earth or fill) acres acres Roads, buildings and other paved surfaces acres acres Other (Indicate type) acres acres 3. What is predominant soil type(s) on project sitez a Soil drainage: [~Well drained % of s, ite [~Moderate.ly well drained % of site [~oorly drained ~/O O % of site b. If any agricultural land is involved, how many acres of soil are classified within soil group I through 4 of the NYS Land Classification System? acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? ~Yes J~No --~ a. What ~s depth to bedrock~ [in feet) 2 · 5. 'Approximate perce ¥ 6. Is project substan Registers of Histor 7. Is project substant 8. What is the depth 9. Is site located ow 10. Do hunting, fishi 11. Does project sit, f~Yes Identify 12. Are there any ur [:]Yes 13. Is the project s I~Yes 14. Does the prese[ I~Yes 15. St~ean~s within c a. Name ~e of proposed project site with slopes: '~'0-10% % [10-15% % [15% or greater % y contiguous to, or contain a building, site. or district, listed on the State or the National 'laces? []Yes ~.No / contiguous to a ~ite listed on the Register of National Natural Landmarks? [Yes "~No the water table? (in feet) primary, principal, or sole source aquifer? [~Yes '[~No )r shell fishing opportunities presently exist in the project area? [~Yes ~[~No ]ntain any species of plant or animal life that is identified as threatened or endangered? No According to h species ,e or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations) No Describe presently used by the community or neighborhood as an open space or recreation area? No If yes, explain te include scenic views known to be important to the community? No )ntiguous to project area: Stream and name of River to which it is tributary 16. Lakes, ponds, w( a. Name 17. Is the site serve( a) If Yes, does s b) [f Yes, will ir~ 18 Is the site Iocat Section 303 and 19. Is the site Iocat( of the ECL. and 20 Has the site eve ~d areas within or contiguous to proiect area: b. Size (In acres) ~xisting public utilities? ~,'Yes [No cient capacity exist to allow connection? '~Yes [No ,vements be necessary to allow connection? [Yes ~'No in an agricultural district certified pursuant to Agriculture and Markets Lass,, A~ticle 25-AA, [~Yes J~'No ~ or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8 ?~'CRR 6177 [Yes [No ~en used for the disposal of solid or hazardous wastes? [Yes '~No B. Project Desc 1. Physical dimensic a. Total contigt b. Project acre. c. Project acre~ d. Length of pr e. If the pro}cc f. Number of o h If residential Inihally Ultm~ately i Dimensiol~s ( i.- Linear feet o r'i~)tion andscaleof project (fill in dimensions as appropriate) s acreage owned or con?olle,d by p. roject sponsor "~")~ to be developed: ~7// '~ ~ "~-'~'~-~ i nit ia IIy; '~/. to remain undeve!oped acres. :t, in miles: (If appropriate) an expansion, indicate percent of expansion proposed %; treet parking spaces existing ; proposed u[ar trips generated [)er hour ,/~*-,.) (upon completion of projectJ? · umber and type of housing u/l!ts: One Famd,/ Two'Family Multiple Famdy ultimately. Condominium eet) of largest proposed structure height: ~ ¢width; ~]1~/ length. ~ntage along a public thoroughfare project will occupy i~? 2. How much natural material (i.e.. rock, earth, etc.) will be removed from the site? 0 3. Will disturbed areas be reclaimed? ~r'es []No [N/A a. If yes, for what intend_Z purpose is the site being reclaimed? b. Will topsoil be stockpiled for reclamation? [Yes [:]No c. Will upper subsoil be stockpiled for reclamation? ~qYes [:]No 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? (~) acres. 5. Will any matu~e~forest (over 100 years old) or other locally-important vegetation be removed by this project? [Yes [~o ' 6. If single phase project: Anticipated period of construction / montl~, (including demolition). 7. If multi-phased: a. Total number of phases anticipated (number). b. Anticipated date of commencement phase I month c. Approximate completion date of final phase month d. Is phase I functionally dependent on subsequent phases? [Yes E]No- 8. Will blasting occur during construction? []Yes J~No ', 9. Number of jobs ge~nerated: during construction 2. ; after project is complete ,/ 10. 'Number of jobs eliminated by this project 11. WdJ project require relocation of any projects or facilities? [Yes ,,~No If yet, ~xplain tons/ct~bic ,yar~s year, (including demolition). year. 12. ls surface liquid waste disposal involved? '~PFes [:]'No b. Name of water body into which effluent will be discharged ~/~/.'/~'/ ~-J"e'~'~J~, , 13. Is subsurface liquid waste disposal involved? E3Yes '~No Type proposal? '''[' ~ ~e S'~ 14. Will surface area of an existing water body increase or decrease by ENo Explain 15. Is prolect or any portion of project located in a 100 year flood plain? es 16 \Viii the project generate solid waste? [Yes a. If yes, what is the amouat per month tons b. If yes, will an existing solid waste facility be used? [Yes [~No c. If yes, give name ; location d. Will a:nr.Y wastes not go into a se~.vage disposal system or into a sanitary landfill? [~Yes ENo e. If Yes, explain 17. Will the proiect involve the dispersal of solid waste? a. If yes, what is the anticipated rate of disposal? b. If yes, what is the anticipated site life? 18. Will project use herbicides or pesticides? []Yes [Yes "~o tons/month. ' years. 19 Will project routinely produce odors (more than one ho,ur per day)? ~Yes j~No 20. Will project produce operating noise exceeding the local ambient noise levels? [~Yes 21. Will prolect result in an increase in energy use? []Yes ]~No If yes , indicate type(s) 22. If water supply ~s from ~vells, indicate pumping capacity gallons/minute. 23. Total anUcipated water usage per ~ ;~O gallons ' 24. Does profect involve Local, State or Federal funding? ~Yes ~"No ~ If Yes, explain ~No 4 25.',Approvals Require h Type Submittal Date City, Town, Village Bc trd I~Yes X~No City, Town, Village PI nning Board '~Yes I~No City, Town Zoning Bo rd OYes E3No City, County Health E: ~partment ~lYes '[~'No Other Local Agencies ~]Yes [;~o Other Regional Agent es l-lYes 'l~No State Agencies J~'¥es I-1No Federal Agencies EYes I~No C. Zoning and Panning Information 6 7 What are the prec g. Is the proposed 9 If the proposed a a. What is 10 Will proposed ac 11 Will the propose fire protection)? a. If ,/es, is 12. Will the propose a. If yes, is 1. Does proposed ac~ on involve a planning or zoning decision? I~Yes ~'~o _ If Yes, indicate d cision required: fqzoning amen Iment [~zoning variance [~specia[ use permit Qsubdivision [~site plan ~]new/revision )f master plan [resource management plan [~other 2. What is the zonin classification(s)of the site? C 3. Whati:~he~_~po~elopmentofthesiteif. . developed as permitted by the present zoning? 4. What is the propc ,ed zoning of the site. -.,.. · 5. What is the maxm um ~development of the site if developed as permitted by the proposed zoning? Is the proposed a( .ion consistent with the recommended uses in adopted local land use plans? Xl~Yes [~No )minant land use(s) and zoning classifications within a ;4 mile radius of proposed action? ction compatible with adjoining/surrounding land uses within a ~,4 mile? <~es []No tion is the subdivision of land. how many lots are proposed?'~-- ~ ~e minimum lot size proposed? - ion require any authorization(s) for the formation of sewer or water districts? [~Yes '~,1o ] action crea~e a demand for any community provided services (recreation, education, police. I~Yes~1~o ,xisting capacity sufficient to hand e proiected demand~ OYes ONo action result in the generation of traffic s~gnificantly above present levels? I~Yes ~'No he existing road network adequate to handle the additi.onal traffic? ~lYes [~No D. Informational Attach any addi~ impacts associated w avoid them. Details onaJ information as may be needed to clarify 'your project. If there are or may be any adverse h your proposal, please discuss such impacts and .the measures which you propose to mitigate or E. Verification I certify that/the informat..)~ provided~;~ove is_(r%e~o the best of my knowledge. __ Applicant/SJ~j~iZSr N[ rne ,,~--/~, ~,/ ~- ~ ,~ ~ Date Signature~ ~. ~~ Title I[ t~e actioA is i. ~e. oastal A~ea, and you are a slate agency, complete the Coaslal Assessme,l Fo~m beiore proceedi,g with Ibis assessme,l. 5 Part 2--PROJECT IMPACTS AND THEIR MAGNITUDE Responsibility of Lead Agency ~ "· General Information (Read Carefully) · In completing the form the reviewer should be guided by the quesbon: Have my responses and determinations bee, 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 significant, Any large impact must be evaluated in PART 3 to determine significance. Identifying an impact in column 2 simpl, asks that it be looked at further. · The Examples provided are to assist the reviewer by showing types of impacts and wherever, pgssible the threshold o~ magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State anc for most situations. But, for any specific proiect or site other examp)es and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. · The impacts of each project, 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. - - Instructions (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. I~ 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 impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This must be explained in Part 3. IMPACT ON LAND 1 Will the proposed action result in a physical change to t~e proiect site? "~NO []YES Examples that would apply to column 2 · Any construction on slopes of 15% or greater, (15 foot rise per 100 [] [] []Yes [~No foot of length), or where the general slopes in the project area exceed 10%. ·Construction. gn land where the depth to the water table is less than [] [] []Yes I--INo 3 feet. · Construction of paved parking area for 1,000 or more vehicles. E] . [] ~]Yes [-~No · Construction on land where bedrock is exposed or generally within [] [] I-~Yes []No 3 feet of existing ground surface. · Construction that will continue for more than 1 year or involve more [] [] [~Yes []No than one phase or stage. · Excavation for mimng purposes that would remove more than 1,000 [] [] L~Yes [~No tons of natural material (i e., rock or soil) per year. * Construction or expansion of a sanitary landfill. ~ [] []Yes []No · Construction in a designated floodway [] [] []Yes [~No · Other impacts ~ [] ~Yes []No I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact' Irhpact Project Change 2 ~.%,'ill there be an effect t~. -..W uh,que or unusual land forms found on the site? (i e., cliffs, dunes, geological formations, etc.)~NO E~YES · Speofic land forms: [] _-, [] [~Yes [-]No IMPACT ON WATER 3. Will proposed a~ r ® affect any water body designated as protected? (Under Articles 1 ~4, 25 of the Environmental Conservation Law. ECL) ~j~NO L~YES Examples that w Ld apply to column 2 · Developable area f site contains a protected water body. · Dredging more tt 100 cubic yards of material from channei of a protected stream · Extension of utilit' ~stribution facilities through a protected water body. · Construction in a :esignated freshwater or tidal wetland. · Other impacts: _ 1 Small to Moderate Impact 2 3 Potential Can Impact Be Large Mitigated By Impact Project Change [] []Yes []No [] []Yes []No [] [~Yes I--]No [] DYes []No [] []Yes []No 4. Will proposed a ' on affect any nomprotected existing.._.or new body of water? [~NO ~]YES Examples that s~ ,Id apply to column 2 · A 10% increase , decrease in the surface area of any body of water or more than a I tcre increase or decrease. · Construction off ody of water that exceeds l0 acres of surface area. · Other impacts:. [] []Yes []No [] I'-]Yes [-INo [] []Yes []No 5. Will Proposed , quality or quan Examples that ~ · Proposed Action · Proposed Actio~ have approval tr · Proposed Action gallons per min · Construction or supply system. tion affect surface or groundwater /? ~/NO OYES dd apply to column 2 ill_requtre a discharge permit. equires use of a source of water that does not erve proposed (proiect) action. quires water supply from wells with greater than 45 ~ pumping capacity· · eration cousins any contamination of a water · Liquid effluent do not exist or · Proposed Actio day. · Proposed Actio, · Proposed Actior ..ill adversely affect groundwater· be conveyed off the site to facilities which presently .,e inadequate capacity. .¥ould use water in excess of 20,000 gallons per All likel,., cause siltation or other discharge into an existing body of..tertotceex(entthattherewd[beanobviousvisual contrast to hater ~ conditions · Proposed Actio .,vii[ require the storage of petroleum or chemical products greate 'hah 1,100 gallons. · Proposed Actio .vdl allow residential uses in areas without water and/or sewer se cos. · ProposedAcbo~ )cafes commercial and/or industrial uses which may facHR~es. · Other impacts [] []Yes ~]No [] []Yes []No ~ []Yes []No [] []Yes [~No [] i--]Yes []No [] []Yes []No [] []Yes ~]No [] -- ~Yes ~No' [] []Yes.. ~]No [] []Yes []No [] []~es [~No [] []Yes []No 6 Will proposed water runoff? Examples that · Proposed Actio ctlon alter drainage ~Jow or patter~ or surface L~NO ~YES · )utd apply to column 2 ,~ould change flood ~¢ter flows. 7 [] []Yes I~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: 1 Small to Moderate Impact 2 Potential Large Impact 1, Can Impact B'e Mitigated By Project Change [] [] EYes []No [] [] {-lYes []No [] [] J~]Yes J-qNo i [] [] - []Yes E~No IMPACT ON AIR ~ 7 Will proposed action affect air quality? '~NO rE]YES Examples that would apply to column 2 · Proposed Action will induce 1,000 or more vehicle trips itt any given hour. · Proposed Action will result in the incineration of more than I ton of refuse per hour. · Emission rate of total contaminants will exceed $ lbs. per hour or a heat source producing more than 10 million BTU'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: [] [] []Yes [--JNo [] [] [~]Yes [--INo [] [] []Yes '[]No [] [] ~Ves [::]No [] [] []Yes []No [] [] []Yes E]No IMPACT ON PLANTS AND ANIMALS 8 Will Proposed Action affect any threatened or end.red species? ]II~N O ~]YE$ 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 o0 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 [] -' [] []Yes J~3 No [] [] E-]Yes E~No [] [] [~]Yes []No [] [] []Yes []No 9 wire Proposed Action substantially affect non-threatened or non-endangered species? ~'NO Examples that would apply to column 2 · Proposed Action would substantially interfere with any resident or m~gratory fish. shellfish or wildlife species. · Proposed Action requires the removal of more than 10 acres of mature forest (over 100 years of age) or other locally i'mportant ~egetation. IMPACT ON AGRICULTURAL LAND RESOURCES 10 Will the Proposed Action affect agricultural land resources? '~NO E_qYES Examples that would apply to column 2 · The proposed action would sever, cross or limit access to agricultural land (includes cropland, hayfields, pasture, vineyard, orchard, etc.} [] [] []Yes E]No [] [] []Yes J:]No [] [] []Yes ~]No · Construction activit~ .vould excavate or compact the soil profile of a§ricu]tural [and. · The proposed action vould irreversibly convert more than 10 acres of agricultural land , r, if located in an Agricultural District, more than 2.5 acres of agT~ 'ultural land. · The proposed action ', ould disrupt or prevent installation of agricultural land management sy~ ems (e.g, subsurface drain lines, outlet ditches. strip cropping); or cr~ rte a need for such measures (e.g. cause a farm field to drain poorly lue to increased runoff) · Other impacts: 1 Small to Moderate Impact 2 3 Potential Can Impact Be Large Mitigated By Impact Project Change [] I--lYes [~No [] [-lYes [~No [] []Yes [-)No [] ~]Yes []No IMPAC" ON AESTHETIC RESOURCES~_ 11 Will proposed acli )n affect aesthetic resources? ~[.NO [~YES (If necessary, use the Visual EAF Addendum in Section 617.21, A13pendix B.) Examples that wc,,Id apply to column 2 · Proposed land uses 3r proiect components obviously different from or in sharp contrast ~ ) current surrounding land use patterns, whether man-made of natura. · Proposed land us( , or proiect components visible to users of aesthetic resources ,~hich will eliminate or significantly reduce their enjoyment of the a,! thetic qualities of that resource. · Project component; that will result in the elimination or significant screening of scemc Jews known to be important to the area. · Other impacts: ___ [] []Yes []No [] [~Yes []No [] [~Yes []No [] []Yes []No IMPACT ON HIST'.' RIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed A:'.ion impact any site or structure o~historic, pre- historic or palem tological importance? ~TNO [~YES Examples that woL Id apply to column 2 · Proposed Action o: :urring wholly or partially within or substantially contiguous to an,,' f ~ tility or site listed on the State or National Register of historic places. · Any impact to an .~ chaeological site or fossil bed located within the prolect site. · Proposed Action ~:ll occur in an area designated as sensitive for archaeological s~te; on the NYS Site Inventory. · Other impacts:___ -~ [] .. []','es []No [] []Yes. []No [] []Yes [-INo [] r~Yes []No IMPACT C N OPEN SPACE AND RECREATION 13 Will Proposed ~. uon affect the quantity or quality of existing or future open spaces or recreational opportumties? Examples that ~,,uld apply to column 2 '~NO [~YES · The permanent fo' .closure of a future recreational opportunity. · A ma]or reduction of an open space important to the community. · Other ~mpacts: __ [] [] []Yes [--]No [] -~, [] []Yes r-]No [] [] r-]Yes []No 1 2 IMPACT ON TRANSPORTATION Small to Potential 14. 'Will there be an effect to existing transportation~.s_.tems? Moderate Large ~NO E3YES Impact Impact 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: [] -J~ Can Impact E Mitigated B) Project Chant. [:]Yes []Nc I-lYes []Nc [~Yes [=]Nc IMPACT ON ENERGY 15. Will proposed action affect the community's sou~cesof fuel or energy supply? ~'NO F-)YE S 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. · Proposed Action will require the creation or extension of an energy [] transmission or supply system to serve more than 50 single or two fami}y residences or to serve a major commercial or industrial use. · Other impacts: [] [] []Yes J-]No [] []Yes []No []. E]Yes []No NOISE AND ODOR IMPACTS 16. Will there be objectionable odors, noise, or vibration as a result of the Proposed Action? '~'NO [~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 barrie/s that would act as a [] noise screen. · Other impacts: [] [] [~Yes [~No [] []Yes []No [] [-]Yes []No [] []Yes []No [] []Yes []No ~;' IMPACT ON PUBLIC HEALTH 17. Will Proposed Action affect public health and saf~'~NO [gYES 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 "hazardous wa'stes" in any [] form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, inl'ectious, otc j · Storage facilities for one mdlion or more gallons of ]iquitied natural [] gas or other flammable liquids. · Proposed action may result in the excavation or other disturbance [] w~thin 2.000 i~eet of a site used i:or the disposal oi: sohd or hazardous waste. · Other impacts: ' '~] 10 [] []Yes- . []No [] []Yes []No [] []Yes []No [] []Yes I=]N0 [] []Yes []No IMPAC- ON GROWTH AND CHARACTER Small to Potential OF CCMrVlUNITY OR NEIGHBORHOOD Moderate Large 18. Will proposed ac io~ affect the character of the existing community,f Impact Impact "~'NO []YES Examples that w ,uld apply to column 2 · The permanent po ~ulation of the city, town or village in which the [] [] []Yes I--INo project is located i likely to grow by more than 5%. · The municipal buc:~et for capital expenditures or operating services [] [] ' []Yes []No will increase by mc re than 5% per year as a result of this project. · Proposed action w II conflict with officially adopted plans or goals. [] [] []Yes []No · Proposed action w !1 cause a change in the density of land use. [] [] []Yes []No · Proposed Action w ri replace or eliminate existing facilities, structures [] [] []Yes []No or areas of historic importance to the community. · Development will ( re~te a demand for additional community services [] [] []Yes C]No (e.g. schools, polic~ and fire, etc.) · Proposed Action w II ~et an important precedent for future projects. [] [] []Yes C]No · Proposed Action w Il create or eliminate employment. [] [] []Yes '[]No · Other impacts:____ [] [] []Yes []No 3 Can Impact Be Mitigated By Project Change 19. ls there, or is there likely to be, public controversy related to potential adverse environmental impacts? "~'NO [~YES If Any Action in Part 2 Is Identified as a Potential Large Impact or If Yot~ Cannot Determine the Magnitude of Impact, Proceed to Part 3 Part 3--EVALUATION OF THE IMPORTANCE OF IMPA3TS 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 fop each impact identified in Column 2 of Part 2: 1 Briefly describe tl-e impact. 2. Describe (if applic~ hie) how the impa'ct could be mitigated or reduced to a small to moderate impact by proiect change(s). 3. Based on the info mution available, decide ~f it is reasonable to conclude that this impact is important. To answer the question of importance, consider: · The proba3ility of the ~mpact occurring · The durat on of the impact · Its irrever~lbilitY, including permanently lost resources o~ value · Whether t~e impact can or will be controlled · The reg~o~ al consequence o1' the impact · Its potent~ ]1 divergence from local needs and goals · Whether I~,~own objections to the project relate to this impact (Continue on attact m(,ntsl 11 617.21 Appendix B State Environmental Quality Review Visual EAF Addendum SEQR This fcrm may be used to provide additional information relat.ing to Question 11 of Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Visibility 1. Would the project be visible from: · A parcel of land which is dedicated to and available to the public for the use. enjoyment 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 listed on the National or State Registers of Historic Places? · State Parks? · The State Forest Preserve? · National V/ildlife Refuges and state game refuges? · National Natural Landmarks and other outstanding natural features? · National Park Service lands? · Rivers designated as National or State Wild. Scenic or Recreat onal? · Any transportation corridor of high exposure, such as part of :he interstate System, o,r Amtrak? · A governmentally established or designated interstate or inter-county foot trail, or one formally proposed for establishment or designation? · A~"site, are.a, lake, reservoi~ or highway designated as · Municipal park, or designated open space? · County road;' · State? · Local road~ Project and Resource (in Miles) 0-V4 V4-V2 V2-3 3-5 5+ Is the visibility of the project seasonal? (i.e., screened by summer foliage, but visible during other seasons) [~Yes ~]No Are any of the resources checked in question 1 used by the public during the time of year during whicft the project will be visible? .~Yes ~No " 1 DESCRIPTION OF EXISTING VISUAL ENVIRONMENT 4. From each item checked in question l, check those which generally describe the environment. surrounding Within · 1/4 mile '1 mile Essentially un Jeveloped [] [] Forested [] [] Agricultural [] [] Suburban residential [] [] Industrial [] [] Commercial [] [] Urban [] [] River, Lake, Pond ~mc...~, [] [] Cliffs, Overlooks [ [] [] Designated Open Space [] [] Fiat [] [] Hilly [] [] Mountainous [] [] Other [] [] NOTE: add a~tachments as needed 5. Are there visually similar projects within: *Vz mil.~ ~Yes []No *l miles []Yes [~No *2 miles []Yes [~No *3 miles []Yes []No * Distance from project site are provided for assistance. Substitute other distances as appropriate. EXPOSURE 6. The annual number of viewers ikely to observe the proposed project is NOTE: When user data is unavailable or unknown, use best estimate. CON:'~EXT 7. The situation or activity in which the viewers are engaged while viewing the proposed action is Activity Travel to ancl from work Involved in recreational activities Routine travel by residents At a residence At worksite Other .__ FREQUENCY Holidays/ Daily Weekly' Weekends Seasonally COUNTY OF SUFFOLK ) STATE OF qEW YORK )SS: in compl(.t;[ng this application I hereby authorize, gthe~ Trustees~ agent or representative to enter o~o my property/to, inspect the premises in conjunction with re~t~.a~ ~ o~ __~C~ ~ ,, .. NOTARY~" i'~'~:" ~"~"~Y°rk[',o..~-:<,7~:~-~-"'. ~:''""~"~' ,~,. C~[mt'/~ APPROVED "WETLANDS" PERMIT (CHAPTER 97) APPROVED "EOAT,DOCKS, WHARVES" PERMIT (CHAPTER 32) DISAPPROVED "WETLANDS PERMIT" (CHAPTER 97) DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT CONDITIONS, IF ANY (CHAPTER 32) EXAMINING BODY SIGNATURE OF CHAIRMAN COMPUTATION OF FEES Approved ~/27/85 MATCH -- _~ ~ FOR PARc'.rL NO d'O.~, ., SEE SEC NO. 052 · : 06-00~ %\ Hosho.~omuc# '~\ Pon~ ¢\ LINE t6 t. SA(C'I SEE SEC. NO. 0,52 P^.CEL NO. $£~ S~C 24 t 4.7A I¢) , I I SEE SEC. NO. KEY MAP 2OO o 2oo SCALE I.N FEET (~ COUNTY OF SUFFOLK TOw,o, SOUT'HOLD .o.o Real Property Tax Service Agency vJ,LAO~O~ County Center DISTRICT HO. JO00 ~4 Riverhead, L. I., New York °~o0 O56 PROPERTY MAP