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HomeMy WebLinkAboutTR-5693Board Of Southold Town Trustees SOUTHOLD, NEW YORK PERMITNO. ~.q~. DATE:Jan' z2, z003 .......... ISSUED TO ............... ~g.L.. ~., ~Z?Z.GE,L~LD ......................... ut'l nri atim Pursuant fo the provisions of Chapter 615 of the L~ws of the State of New Yorl~, 1893; and Chapter 404 of the I-~ws of the State of New York 1952; and the Soufhold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS andl the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;!~. and in accordance with the Resolution of The Board adopted afa meeting held ca - 2(~0~,, and in consideration of the sum of $ ~00,00.. . paid by · . Paul. H....Fi~g¢.¥.~ld ............................................ of .... ~.EF.~[~.P.~t, ...... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to relocate existing platform, ramp and float to center of bulkhead - boat slip. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees kere- by causes ifs Corporate Seal to be eff. ixed, and these p.resen~s to be subscribed by ~ majority of the smd Board as of th~s d~fe. ~r~stees TERMS and CONDITIONS residing at 255 Osprey Nest Road, Greenport, N. ¥. as par~ of the comideratioa fo~ the i.s~u~zce of ~e p.*mi¢ does madetxtaml and prescribe to the fol- lowly: t. That the said Board of Trustees and ~e Town o~ Southold ave zeleased f,om any and with respect ~, to the complete exduslon of the Boaxd o~ Tmstee~ o~ dae Tos~ o~ Suuil.old 2. That this Permit is valid for a period of ~4 mo~ whlch is conakleted to be tbe estimated time'required to complete the wotic involved, but d~mld for an ~..iilzslon may be made to the Board at a lat~ ~. That this Permit should be trained indefinitely, or as long as the said to maintain the faucture or project involved, to provide evidence to anyone concerned orization was originally 4. That the work .involved will be *ubject to the inspection and approval of the Bo~cl o~ lt~ agents, and nonq:~mpllance with. the provisiom o~ the otlgitmtlng application, may be cause for revocation of this Pex~t I~ resolution of the said Board. 5. That there will be no un~easonable intexfe~ence with navigation as a reault of ~ wodt herein adthor~-d. 6. That there ~hall he no interference with th* right o~ the ~ to ~ and tepa~ along the beach between high ami low water mark~. wodt shall cause ~le obstrucuon to free navigation, th~ said Petmktec will be re~ uixm due nodce, to remove or slter this work o~ project herein stated without ezpeme~ to the TOWII 8. That the said Board will be notified by the Permittee ot ~he completion Of the wot4c auth- orized. 9- That the Petmittee will obcaln ali other pezmlts sm~ cooseats d~g may be xequlted mp- plemental to this permit which may be mbject to revoke upon l~!!a~e to obtain ~ M~rt J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda \ Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 January 27, 2003 Crowley Marine c/o Susan E. Long PO Box 46 East Marion, NY 11939-0046 RE: SCTM#35-6-34 Paul H. Fitzgerald 255 Osprey Nest Road Greenport, NY Dear Ms. Long: The Board of Town Trustees took the following action during a Regular Meeting, held on January 22, 2003 regarding the above matter. WHEREAS, Crowley Marine c/o Susan E. Long on behalf of Paul H. Fitzgerald applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 30TM, 2002. WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with re*pect to said application on January 22, 2003 at xvhich time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. -~ 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, Safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Paul H. Fitzgerald for a Wetland Pemfit to relocate existing platform, ramp and float to center of bulkhead- boat slip. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of $5.00 per inspection (See attached schedule). FEES: $5.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc / cc DEC ~/ Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda \ Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 January 27, 2003 Crowley Marine c/o Susan E. Long PO Box 46 East Marion, NY 11939-0046 RE: SCTM#35-6-34 Paul H. Fitzgerald 255 Osprey Nest Road Greenport, IxPsr Dear Ms. Long: The Board of Town Trustees took the following action during a Regular Meeting, held on January 22, 2003 regarding the above matter. WHEREAS, Crowley Marine c/o Susan E. Long on behalf of Paul H. Fitzgerald applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated December 30th, 2002. WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Heating was held by the Town Trustees with respect to said application on January 22, 2003 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in questioo and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Toxvn Code. 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, Safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approved the application of Paul H. Fitzgerald for a Wetland Permit to relocate existing platform, ramp and float to center of bulkhead- boat slip. BE IT FURTHER RESOLVED that this detemfination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of $5.00 per inspection (See attached schedule). FEES: $5.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD PAUL H. FIT~.ZGERALD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOAR[) OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE X __ Pre-construction, hay bale line __ Ist day of construction % constructed __ Project complete, compliance inspection. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickereon Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD. OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAIL~LJRE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction ½ constructed __ Project complete, compliance inspection. i SEQRA RESOLUTION RE: PAUL H. FITZGERALD SCTM#35-6-34 Resolved by the Board of Trustees of the Town of Southold that the application of PAUL H. FITZGERALD more fully described in the public hearing section #9 of the Trustee agenda dated Wednesday, January 22, 2003 is, pursuant to the SEQRA rules and regulations, an Unlisted Action; and be it Further resolved that the applicant is required to submit Part 1 of the Long Environmental Assessment Form (LEAF); and be it Further resolved that upon receipt of the LEAF the Clerk of the Trustees is hereby directed to commence a coordinated review pursuant to SEQRA. 1 4-16-~ (9/9S)-- 7c 617.20 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM SEQR Purpose; The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent- Iy. there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine significance may have little or no formal knowledge of the environment or may not be technically expert in environmental analysis. In ad0ition, many who have knowledge in one particular area may not be aware of the broader concerns affecting the question of significance. The full gAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible enough to allow introduction of information to ht a project or action Full EAF Components: The full gAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assist~ a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible impacLs that may occur from a project or action. It provides guidance as to whether an impact is likely to be considered small to moderate or whether it is a potential large impact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact in Part 2 is identified as potential[y-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE--Type I and Unlisted Actions Identify the Portions of EAF completed for this project: [] Part1 [] Part2 []Part 3 Upon review of the information recorded on this gAF [Parts I and 2 and 3 if appropriate), and any other supporting information, and considering both the magnitude and importance of each impact, it is reasonably determined by the lead agency that: [] A. The project will not result in any large and important impact(s) and, therefore, is one which will not have a significant impact on the environment` therefore a negative declaration will be prepared. B. Although the project could have a significant effect o~ the environment, there will not be a ~ignlficant effect for this Unlisted Action because the mitigation me~ures described In PART 3 have been required, therefore a CONDITIONED negatlye declaration will be 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 Declaration is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer (if different from responsible officer] Date PA,-~T 1--PROJECT INFORMATION Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed may havea significan(eftec~ on the env~ro'~ment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any additional information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full E^F will .be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAME ~ ~N~0f dllf~ren~ BUSINESS TELEPHONE · I BUSINE~( ) TELEPHONE STATE , I ZJP COOE Please Complete Each Question--indicate N.A. if not applicable A. Site Description Physical setting of overall project, both' developed gad undeveloped areas. 1. Present land use: f-10rban I'"]lndustrta[ I-ICommerclal C]Forest C]Agrlculture MOther 2. Total acreage of project area: acres. APPROXIMATE ACREAGE Meadow or Brushland (Non-agricultural) Forested Agricultural (Includes orchards, cropland, pasture, etc.) Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) Water Surface Area Unvegetated (Rock, earth or fill) Roads, buildings and other paved surfaces Other (Indicate type) 3. What is predominant soil typ~s) on project site~ a. Soil drainage: -~Well drained % of site nPoorly drained % of site Residential (suburban) [3Rural (non-farm) PRESENTLY AFTER COMPLETION E]Moderately well drained __ % of site b. If any agricultural land is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? /¢/^ acres, (See I NYCRR 370). 4. Are there bedrock outcroppl~gs on project site,' ayes ~gNo a. What is depth to bedrock{' /'~/A (in feet) 2 Approximatepercen[ageof ect site with slopes: ~0-10% ~ % []10-15% % [~'tS*/* or greater % Is pro]ecl substantially contiguous, to, or contain a building, site, or district, listed on the State or the National 6 Registers of Historic Places? EYes 7 Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? [~Yes 8 What is the depth of the water table? AlIA {in feet) 9. Is site located over a prirriary, principal, or sole source aquifer? ~)Yes (~No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ~.Yes 11. Does project site contain any species of plant or;anifnal life that is identified as th;'eatened or endan§eredl EYes ~No According to ~tJ.<; AN F_.. Lc~ N C, Idendfy each species .. · 12. Are there any unique or unusual land forms on the project site? (i.e.. cliffs, dunes, other geological formations) [~Yes (~No Describe A~ 13. Is the project site presently used by the community or ne[ghborhooo an open space'or recreation EYes ~No . If yes, explain 14. Does the present site include scenic views known to be important to the community? EYes ~No 1S. Streams within or contiguous to projec~ area: a. Name of Stream and name of River to which it is tributary 16. Lakes, ponds, wetland areas withir~ or contiguous to project area: a. Name ~. ['~t__l_ ~i:~l~'~ b. Size (In acres) Iot¥'r 17. Is the site served by existing peb!ic utilities~' lil~Yes ENo a) If Yes, does sufficient capacity exist to allow ¢onnectioni' E-lYes ~No b) If Yes, will improvements be necessary to allow connection? EYes ~No 18. Is the site located in an agricultural district certified pursuant to AgriCulture and Markets Law, Article 2S-AA, Section 303 and ~)4i' I-lyes ~No 19. I~ the site located in or substantially contiguous to a Critical £n~imnmental Area designated pursuant t6 Article 8 of the ECL, and 6 NYCRR 617i' I'-IYes ~'INo ' 20. Has the site ever been used for the .d'isposal of solid or hazardous wastesi' EYes ENo B. Project Description 1. Physical dimension.s and scale of proiect (fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled' by prolect sponsor t~ b. Project acreage to be developed: .~.(Z~- acre's I'niti~;lly; c. Project acreage to remain und~ped r~lJacre,. d. Length of project, in miles: _ ,- . (If approl~;iS~te)· e. If the project is an expansion, indicate percent of expansion proposed /~,f~ %; f. Number of off-stre'et parking spaces existing ~(~ proposed _ ' ' '. g. M~imum vehicular trips generated per hour ' ~(.~. · (upon' completion of project)i' h. If residentlah Number and type of housing unlt~: One F~tmlly Two Family Multiple Family Initially ~ ,~.,~ Ultimately 1. Dimensions (in feet} of largest proposed structure height; width; j. Linear feet of frontage along a public thoroughfare project will occupy 3 acres. acres ultimately. Condominium length. fL 2 How much natural material (i.e., rock, earth, etc. I wiU be removed from the site? 3. Wdl d~sturbed areas be reclaimed? DYes DNo ~N/A a If yes. for what intended purpose is the site being reclaimed? NI,4. b. Will topsoil be stockpiled for reclamation? OYes c Will upper subsoil be stockpiled for reclamation? I~Yes [~No 4 How many acres of vegetation (trees, shrubs, groun~ covers) will be removed~rom site? ' --¢- acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? C)Yes ~No 6. [f single phase project: Anticipated period of construction O~ F months. (including demolition). 7. If multi-phased: a. Total number of phases anticipated ~N~. (number). b. Anticipated date oi' commencement phase 1 month c. Approximate completion date of final phase month __ d. Is phase I functionally dependent.on subsequent phases? C1yes E]No 8. Will blasting occur during construction? ' I~Yes ~No 9. Number of jobs generated: during construction , ~' ; after project is complete 10. Number of jobs eliminated by this project -o .'- 11. Will project require relocation of any projects or facilities? I-lYes I~lNo If yes. explain 12. Is surface liquid waste disposal involved? OYes I~No a. If yes, indicate type of waste (sewage, industrial, etc.) and amount b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? [~Yes E3No Type /~ I A 14. Will surface area of an existi,~g ~,ater body increase or decrease by proposal? I'-)Yes' i~No Explain ti 15. Is project or any portion of project located I~ a 100 year flood plain? OYes I-iNo 16. Will the project generate solid waste? ' i-lYes 171No a. If yes. what is the amount per month N'!:A tons b. If yes, will an existing'solid waste facility be used? I-lYes E3'No c. If yes. give name . .~]A ; location N/," d. Will any wastes not go into a sewage disposal system or into a sanitary landfill;[ [~Yes ,~No e. If Yes, explain .. tons/cubic yards year, (including demolition). year. , 17. Will the project involve the disposal of solid waste? a. If yes, what is the anticipated rate of disposal? b. If yes, what is the anticipated site life? N}A 18. will project use herbicides or pesticides? ~Yes I-lYes ~No [/4' tons/month. years. J~No 19. Will project routinely produce odors (more than one hour per day)? ~Yes I~No 20. Will project produce operating noise exceeding the local ambient noise levels? ~Yes 21. Will project result in an increase in energy use;[ [~Yes ~No If yes , indicate typ~(s) water supply is from wells, indicate pumping capacity .N.]A gallons/minute. 22. If 23. Total anticipated water usage per day /~/,,4 · gallons/day. 24. Does project involve Local, State or Federal funding? I-Wes ~No I( Yes. explain J~No 25. Approvals Required: C,[y To,,,,n, ¥',llage Board ~Yes C~t¥. Town Zoning Board []Yes C~t¥. Count,/ Health Department [3Yes Other Local Agencies I;~es [3No Other Regional Agencies ' OYes State Agencies ~Yes [2)No Federal Agencies Res ONo SubmiHal Type Date C. Zoning and Planning Information I Does proposed action involve a planning or zoning decision? [3Yes ~No If Yes. indicate decision required: nzoning amendment I~zoning variance Clspecial use permit [3subdivision Dsite plan [~new/revision of master plan (3resource management plan [3other 2 What is the zoning classification(s)of the site? 1RILS I_~=ktTI .~L 3. What is the maximum potential development of the site if developed as permitted by the present zoning? 4. What is the proposed zoning of the site? S. What is the maximum potential development of the site if developed as permitted by the proposed zoning? 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? [~Yes IDNo 7. What are the predominant land use(s) and zoning classifications within a ',4 mile radius of proposed action? 8. is the proposed action compatible with adjoining/surrounding land uses within a '4 mile? D~Yes DNo 9. If the proposed action is the subdivision of [and~ how many lots are proposed? /~. !,'~ a. What is the minimum lot size proposed? /~/A 10. Will proposed action require any authorization(s) for the formation of sewer or water districts? [DYes ~No 11. Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? I-lYes I~INo a. If yes. is existing capacity sufficient to handle projected demand? I-lYes [3No 12. Will the proposed action result in the generation of traffic significantly above present levels? [3Yes ,~No a. If yes, is the existing road network adequate to handle the additional traffic? [3Yes {2]No D. Informational Details Attach any additional information as may be needed to clarify your project, If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to rnitigace or avoid them. F_ Verification I certify that the information provided above is true. to the best of my knowledge. with this ~se~m~nt, 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 question: Have my responses and determinations been reasonab[e't The reviewer is not expected to be an expert environmental analyst. · The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the thresh•id of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any specific project or site other examples 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 constitut~ 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, c~nsider long term, short term and cumlative elfects. Instructions (Read carefully) a. Answer each of the 20 questions In PART 2. Answer Yes If there will be any Impact. b. Maybe answers should be considered as Yes answers. c.. If answering Yes to a question then check the appropriate box (column 1 or 2) to Indicate the potential size of the impact. II 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. 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 simply asks that It b~ looked at further. e. If reviewer has doubt about size of the Impact then consider the Impact as potentially large and proceed to PART 3. f. 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 t? [he project site~ I-lNg OYES Examples that would apply to column 2 · Any construction on slopes of 15% or greater, (15 foot rise per 100 foot of length), or where the general slopes in the project area exceed 10%. · Construct[on on land where the depth to the water table is less than 3 feel · Construction of paved parking area for 1,000 or more vehicles. · Construction on land where bedrock is exposed or generally within 3 feet of existing ground surface. · Construction that will continue for more than 1 year or involve more than one phase or stage. · Excavation for mining purposes that would remove more than 1,000 tons of natural material (i.e., rock or soil) per year. · Construction or expansion of a sanitary landfill. · Construction in a designated floodway. · Other impacts 2. Will there be an effect to any unique or unusual land forms found on the sitei' (i.e., cliffs, dunes, geological formations, etc.)OHO OYES · Specific land forms: 6 1 2 3 Small to Potential .Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] O OYes OHo [] 0 OYes ON• 0 O OYes ONe O O OYes ONo O O OYes ONo O O OYes OHo O O OYes O~o O O OYes OHo O .[] OYes O ~ ~Ye~ ~o IMPACT ON WATER 3 Wdl proposed action affect any water body designated as protected~ (Under ^rticles 15, 24, 25 of the Environmental Conservation Law, ECL) ONO [:]YES E~amples that would apply to column 2 · DeYelopab~e area of site contains a protected water body. · Dredgin8 more than 100 cubic yards of material from channel of a protected stream. · Extension of utility distribution facilities through a protected water body. · Construction in a designated freshwater or tidal wetland. · Other impacts: 4. Will proposed action affect any non-protected existing or new body of water? F1NO OYES Examples that would apply to column 2 · A 10% increase or decrease in the surface area of any body of water or more than a 10 acre increase or decrease. · Construction of a body of water that exceeds 10 acres of surface area. · Other impacts: 5. Wilt Proposed Action affect surface or groundwater quality or quantity;~ ONO nyES Examples that would apply to column 2 · Proposed Action will require a discharge permit. · Proposed Action requires use of a source of water that doe~ not have approval to serve proposed (project) action. · Proposed Action requires water supply from wells with greater than 45 gallons per minute pumping capacity. · Construction or operation causing any contamination of a water supply system. · Proposed Action will adversely affect groundwater. · Liquideffluentwillbeconveyedoffthesltetofacilitieswhlchpresently do not exist or have inadequate capacity. · Proposed Action would use water in excess of 20.000 gallons per day. · Proposed Action will likely cause siltation or other discharge into an existing: body of water to the extent that there will be an obvious visual contrast to natural conditions. · Proposed Action will require the storage of petroleum or chemical product~ greater than 1.100 gallons. · Proposed Action will allow residential uses in areas without water and/or sewer services. · Proposed Action locates commercial and/or industrial uses which may require new or expansion of existing waste treatment and/or storage facilities. · Other impac[~: 6. Will proposed action alter drainage flow or patterns, or surface water runofH OHO OYES £,,mples that would apply to column 2 · Proposed Action would change flood water flows. 7 1 2 3 Small to Potential Can Impact 8e Moderate Large Mitigated By Impact Impact Project Change [] [] []Yes [~No [] [] •Yes []No [] El DYes [~NO [] O []Yes 0 0 OY~ 0 0 OY*~ ~ ~ ~Yes ~No ~ ~ DYes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ D ~Y~s ~No ~ ~ ~Ves ~ ~ ~Yes Proposed Action may cause substantial erosion. Proposed ,X, ction is incompatible with existing drainage patterns. Proposed Action w~ll allow development in a designated floodway. Other impacts: IMPACT ON AIR . Will proposed action affect air quality? ~]NO OYES EzampJes that would apply to column 2 Proposed Action will induce 1,000 or more vehicle trips in any given hour Proposed Action will result in the incineration of more than 1 ton of refuse per hour Emission rate of total contaminants will exceed 5 lbs. per hour or a heat source producing more than 10 million BTU's per hour. Proposed action will allow an increase in the amount of lar~d committed to industrial use. Proposed action will at[ow an increase in the density of industrial development within existing industrial areas. Other impacts: IMPACT ON PLANTS AND ANIMALS Will Proposed Action affect any threatened or endangered species? ~NO OYES 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. Applica{ion of pesticide or herbicide more than twice a year, other than for agricultural purposes. O(her impacLs: ~. Will Proposed Action substantially affect non-threatened or non-endangered speciesi' ~NO OYI:S I:,amples that would apply to column 2 · Proposed Action would substantially Interfere with any resident or migrato~ 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 important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES 0. Will the Proposed Actiorr affect agricultural land resources~' C3NO OYES E.;~mples that would apply to column 2 The proposed action would sever, cross or limit access to agricultural )and (includes cropland, hayfields, pasture: vineyard, orchard, etc.) 1 2 3 Small to Potential Can Impact Be Moclerate Large Mitigated By Impact Impact Project Change O [] OYes ONo [] [] OYes ONo [] O []Yes O~o [] O []Yes [] []' []Yes ~ ~ OYes ~mo ~ ~. Oyes ~No ~ ~ ~Yes ~No ~ ~ OYes ONo · Construction 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 Agricultural District, more than 2.5 acres of agricultural land. · The proposed action would disrupt or prevent installation of agricultural land management systems (e.g.. subsurface drain lines, outlet ditches, strip cropping); or o'eate a need for such measures (e,g. cause a farm fmld to drain poorly due to increased runoff) ·O[her impacts: IMPACT ON AESTHETIC RESOURCES 11. Will proposed action affect aesthetic resources? OHO E]YES (if necessary, use the Visual EAF Addendum in Section 617.20, Appendix B.) Examples that would apply to column 2 · Proposed land uses, or project components obviously different from or in sharp contras~ to current surrounding land use patterns, whether man-made or natural. · Proposed land uses, or project components visible to users of aesthetic resources which will eliminate or significantly reduce their enioyment of the aesthetic qualities of that resource. · Project components that will result in the elimination or significant screening of scenic views I(nown to be important to the area. · Other impact~: IMPACT ON HIST.ORIC AND ARCHAEOLOGICAL RESOURCES 12. Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? ONO OYES Examples that would apply to column 2 · Proposed Action occurring wholly or partially within or substantially contiguous to any facility or site listed on the State or National Register of historic places. · Any impact to an archaeological site or fossil bed located within the project site. · Proposed Action will occur in an area designated as sensitive for archaeological sites on the NYS Site Inventory. · Other impacts: IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities~' Examples that would apply to column 2 I-INO OYES · The permanent foreclosure of a future recreational opportunity. · A ma~or reduction of an open space important to the community. · Other impacts: I 2 3 Small to Potential Can Impact Moderate Large M~Iigated Impact Impact Project Cha [] [~ FIYes [] [] [] []Yes [] [] [] [--]Yes [] 0 f-I DYes [] [] [] DYes [] [] [] []Yes [] [] [] []Ye~ [] [] [] []Yes [] [] [] Oyes [] ~ ~ DYes ~ IMPACT ON CRITICAL ENVIRONMENTAL AREAS Will Proposed Action impact the exceptional or unique character- ~st/cs ol a critical environmental area (CEA) established pursuant to subd~,,s~on 6 N~CRR 617 14(8) ~' []NO List the environmental characteristics that caused the designation ol the CE,*, Examples that would apply to column 2 Proposed Action to locate within the CEA? Proposed Action will result m a reduction in the quantity of the resource? Proposed Action will result in a reduction in the quality ot the resourceS' Proposed Action will impact the use, function or enjoyment of the Other ,mpacts IMPACT ON TRANSPORTATION $ Will there be an effect to existing transportation systems? · E3NO ESYES [xampies that would apply to column 2 Alteration ot present patterns of mo')ement of people and/or §oods. Proposed Action will result in major traffic problems Other impacts: IMPACT ON ENERGY 6, Vv,II proposed action affect the community's sources of fuel or energy supply? f-INO E3YES Examples that would apply to column 2 Proposed Action will cause a greater than 5% increase in th~ 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 family residences or to ser','e a major commercial or industrial use. Other impacts' 10 I 2 3 ~ Small to Poten'tial Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] [~] Yes E~]No [] [] ~]Ves ~]No [] ~ ~Ves ~No ~ g ~Ves ~NO ~ ~ ~ves ~No ~ ~ ~Yes ~No ~ ~ ~Ves ~o ~ ~ ~Yes ~No NOISE AND ODOR IMPACTS l? Wdl there be objectionable odors, noise, or vibration as a result of the Proposed Action? ONO OYES Examples that would apply to column 2 · Blasting within 1,500 feet of a hospital, school or other sensitive iac,hty. · Odors wilt occur routinely (more than one hour per day). · Proposed Action will produce operating noise exceeding the local ambient noise levels for noise outside of structures. · Proposed Action will remove natural barriers that would act as a noise screen. · Other impacts' IMPACT ON PUBLIC HEALTH 18. Will Proposed Action affect public health and safety? . [3NO [3YES 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 wastes" in any form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious, etc.) · Storage facilities for one million or more gallons of liquified natural gas or other flammable liquids. · Proposed action may result in the excavation or other disturbance within 2,000 feet of a site used for the disposal of solid o[ hazardous waste. · Other impacts: IMPACT ON GROWTH AND CHARA(~TER OF COMMUNITY OR NEIGHBORHOOD 19. Will proposed action affect the character of the existing communRy? OHO OYES 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 5%. · The municipal budget for capital expenditures or operating services will increase by more than 5% per year as a result of this project. · Proposed action will conflict with officially adopted plans or goals. · Proposed action will cause a change in the density of land use. · Proposed Action will replace or eliminate existing facilities, structures or areas of historic 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 'projects. · Proposed Action will create or eliminate employment. · Other impacts: 1~ 2 3 Small to Potential Can Impact Be Moderate Large Mitigatea By Impact Impact Project Change [] [] []Yes {:]No [] [] E)Yes []No [] [] []Yes EgNo D ~ ~Yes ~o ~ ~ ~Yes ~o D ~ ~Yes ~N0 ~ ~ ~Yes ~No ~ ~ DYes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes D ~ ~Y~s ~No ~ ~ ~Yes ~No ~ ~ DYes ~No 20. Is there, or is there likely to be, public controversy related to potential adverse environmental impacts? ONO OYES It any act~o~ tn Part 2 Is Identified a, a potential large Impact or It you carrot detormtne the magnitude o! lmpack proceed to Pad 3 11 Part 3--EVALUAT. N OF THE IMPORTANCEC I ACTS Responsibility of Lead ^genc¥ Part 3 must be prepared if one or more impact[s) is considered to be potentially large, even if the impact(s) may be mitigated. Instructions Discuss the following for each impact identified in Column 2 of Part 2: I. Briefly describe the impact. 2 Describe (if applicable) how the impact could be mitigated or reduced to a small to moderate impact by project change(s). 3. Based on the information available, decide Jf it is reasonable to conclude that this impact is important. To answer the question of importance, consider: The probability of the impact occurring The duration of the impact Its irreversibility, including permanently lost resources of value Whether the impact can or 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 impa/:t. (Continue on attachments 12 617.20 Appendix B State Environmental Quality Review Visual EAF Addendum SEQR This form may be used to provide additional information relating to Question il of Part 2 of the Fult EAF. (To be completed by Lead Agency) 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 qualltles? · ^ site or structure listed 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 or 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 trail, or one formally proposed for establishment or designation? · A site, area, lake, reservoir or highway designated as scenic? · MunlclFml park, or designated open space? · County road? · State? · Locel road? Distance Between Project and Resource (in Miles) 0-V4 V4-V2 ~5.3 3.5 5 + [] [] [] [] [] [] [] [] [] [] [] [] O [] O O [] O [] [] O [] [] [] [] [] [] [] [] [] [] O [] [] O [] [] [] [] O [] [] [] [] [] [] [] [] [] [] [] [] O [] [] [] O [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] O [] [] [] [] [] [] O 2. ts the visibility of the project seasonal? (i.e., screened by summer foliage, but visible during other seasons) OYes ONo 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? OYes ONo DESCRIPTION OF EXISTING VISUAL ENVIRONMENT 4. From each item checked in question 1, check those which generally describe the environment. Essentially undeveloped Forested Agricultural Suburban residential Industrial Commercial Urban River, Lake, Pond Cliffs, Overlooks De~gnated Open Space Flat Hilly Other i"iOTE: add ettachments as needed surrounding Within mile *1 mile Are there visually similar projects within: '1/2 mile C]Yes [~No · 1 miles r~Yes mina '2 miles I--lYes I--)No '3 miles r-]yes r-]No · Distance from project site are provided for assistance. Substitute other distances as appropriate EXPOSURE 6. The annual number of viewers likely to observe the proposed project is HATE.: 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 Activity Travel to and from work Involved In recreational activities Routine travel by residents At a residence At worksite Other FREQUENCY Holidays/ Daily Weekly Weekends Seasonally [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] (631) 765-1892 Tow~ Hall. 53095 Main Road P.O. Box 1179 ~outhold. New Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, January 15, 2003, the following recommendation was made: PAUL H. FITZGERALD to relocate existing platform, ramp and float to center of bulkheaded beat si/p. Located: 255 Osprey Nest Rd., Greenport. SCTM#35-6-34 The CAC did not make an inspection, therefore no recommendation was made. I UTF_ 1275 HA~TOF] LIS /W OOPER t~'z - FET.~A~ ~?IRO 6~ACH ;REENPORT F 0 50 I00 200 500 ~00 DCAL8 ~N F~ET ¢00 600 ORIGINAL BO.MID OF TO~,~,qN TRUSTEES 1OWN OF ~OUTH~)Li) Use /\ oastnJ krosion Permit &pplicattur~ ".etland Permit Application Maior i.~cc,,cd Xpp/icat~on ~ ~[ ~,'~ Kc:ct.edictS, ;~ ~ t',,hnpIcted,..Xplqic:tt,on~. 5', I)F,c i [ 5["c Il t nllstcd I-,cccffq oI'(' MIIlOF ",.,:,.. ,.t' Xiu,l~,:,n~ ?AU L ~.utl ,IL k ,,u;nx. I~lx M.tp Ntuubcr of Trustees Applicati¢ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: R[F'.lr..K ATto AIA/-- I Area of wetlands on lot: )'oc;"C> square feet Percent coverage of lqt: / o rD Closest distance between nearest existing structure and upland edge of wetlands: [ feet Closest distance between nearest proposed structure and upland edge of wetlands: ) feet Does the project involve excavation or filling? i/No Yes If yes, how much material will be excavated? ~4(.4 cubic yards How much material will be filled7 .~, (~.. cubic yards Depth of which material will be removed or deposited: bi I/iF feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: jAI,.!- 2 Statement of 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): /do- of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: ~ &'T~ ~- Previous use of propert~y.: 15o fi.q- 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 suspende/d by a governmental agency? / No Yes If yes, provide explanation: Project Description (use attachments if necessary): B oA.-r' s L.. t -1::' 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 Sponsor) SE( 'f'FL AT ~ NO If NO. de$cn0e briefly 9,,¢,,oo: V, JATF_.EFP..O~T 3?r_.,AC--~ DOES ACTION INVOLVE A PERMrT ApPROVAl. ~H-r ~,,~,.,,,~. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY STATE OR LOC*ALI? cb s, $ouT OC ANY ASPECT OF THE ACTION HAVE A CURRENTLY VA!.J0 PERMIT OR APRROVAL? ~2. AS A RESULT OF PROPOSED AcTroN WILL EXISTING PERI~tTIAPPROVAL REQUIRE MOOIFICATION? / If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this OVER 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS i U.S. Postal Service U.S. Postal Service CERTIFIED MAIL RECEIPT CERTIFIED MAIL RECEIPT (Domestic Mad Only: No Insurance Co~'erage Provided) U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only: No Insurance Coverage Provided) 7 STATE OF ~W YO~ CO~Y OF S~FOLK $ ~,A¢)/~ B/~ ~c~. , residing at lq f~ Ih F o ~. r7 t~/ , being duly sworn, deposes and says that on the 1113t day of ~3,1,1tJAg,4' ,20*3, deponent mailed a true copy of the Notice set forth in the Board of Trust~es Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the To~rn of Southold; that said Notices were mailed at the United States Post Office at l~Pt~7' t~,~-I~10 M. , that said Notices were mailed to each of said persons by (certified) (registered) mail. ~-~ Sworn to before me this Pay of '3"~lqt?g~ ~ , 20 Notary P ~'~lic SUSAN E. LONG N~tary Public, State of New York No. 01LO4958343 Qualified in Suffolk County Cemmissiorl Expires November 3 NOT~CE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEESt TOWN OF SOUTHOLD In the matter of applicant: YOU ARE HEREBY GIVEN NOTICE: i. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: 2. That the property which is the subject of Environmental Revtew--/s located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: ~-~.~3 You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: ~-I;OW~ N ~ 2rA~.l- D MIRely t MAILING ADDRESS: ~/~ H~R~A~ ~gMl~l~AH PHONE ~: . ~31 q77-3,Y.~ ' Enc.: Copy of sketch or plan showing proposal for your convenience. 1 Albert J. Krupski, President ~74~_~ James King, Vice-President Henry Smith , ~.~I~I Artie Foster Ken Poliwoda ~ Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone ~63I,I 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TO~VN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING _ being duly sworn, depose and say: That on the [~%ay of~ , 2003, I personally posted tbs property known as by placing the Board of ~r--~s~e~s o~ffc'ial p~s~er wher~-~t~can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date o~the public hearJ~n~. Date of he~ring noted thereon to be held~L~/ Dated: Sworn to before me this ~.day of ~--~m._ 2003 Notary Public (signature) ~-~ CLAIRE t. GLE~V Board of Trustees Applicati~ County of Suffolk State of New York ~I_)~.A.~] ~.. ~ 6 BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PEP~MIT(S) AND THAT ~LL STATEME~TfS CONTAINED HE~LEIN TRUE TO THE BEST OF HIS/HER F_NOWLEDGE AND BELIEF, AND %~{AT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION A~ND AS MAY BE APPROVED BY THE SOtFfHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOU~HOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM A~Y AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID. PERMIT(S), IF GR3%NTED. IN COMPLETING THIS APPLICATION, I HEREBY 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. SWORN TO BEFORE ME THIS c~c~ DAY OF /~ Notary Public CLAIRE L. GLEW Notary Public, S:ate of New York No. 01 GL4879505 Qualified in Suffolk PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Ma//Only; No Insurance Cow'rage Provided) L% Addz U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurat~ce Coverage Provided) I UALLE'i .:,i~LAt':- N; c~,~,e~ ~ee I 2 STATE OF NEW YORK COUNTY OF SUFFOLK residing at ~SbP-'~¢P being duly sworn, deposes and says that on the lift% day of ~c~__,~9o3, deponent mailed a true copy of the Notice s~t forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at ~ ./~_~ I~lb~. , that said Notices were mailed to each of said persons by (certified) (registered) mail. Sworn to before me this day of ~-AMtJ~gIf ~ ,~.~o3 SUSAN E. LONG Notary Public, State of N~w York No. O1 LO43583,13 Qualified in Suffolk Cou,~ty NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: SCTM#1000- $3~-g-3 YOU ARE HEREBY GIVEN NOTICE: 1. the Permit from the Board of Trustees to: That it is intention of the undersigned to request a 2. That the property which is the subject of Environmental Review.~s located adjacent to your property and ls described as fol lows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: ~-~-~ You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: MAILING ADDRESS: PHONE ~: f.~}- Enc.: Copy of sketch or plan convenience. showing proposal for your L, :Ab )ard of Trustees Applicatio~ County of Suffolk S%aue of New York ~5~ ~, ~b~6 BEING DULY SWOR/q DEPOSES AND AFFIRMS THAT HE/SHE IS THE AioPLICANT FOR THE ABOVE DESCRIBED PER_MIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN APsE TRUE TO THE BEST OF HIS/HER KNOWLEDGE A/fiD BELIEF, AND THAT ALL WOk~ WILL BE DONE IN THE MJ~NNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOW/q BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOW~ OF SOUq"HOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ~ AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID. PERMIT(S), IF GRANTED. IN COM3LETING THIS APPLICATION, I HEREBY ALPISqORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ON~ MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ~ Signature Notary Public CLAIRE L. GLEW Notary PubJic. State of New York No. O1GL4~79505 Qualified in Suffolk Commission Ex~ires Dec. 8. 7 1.~ 16-2 (9/95)--7c 617.20 Appendix A State Environmental Quality Review FULL ENVJRON.MENTAL ASSESSMENT FORM SEQR Purpose: The full E^F is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may be significant. The question of whether an action may be significant is not always easy to answer· Frequem- I,r. there are aspects of a project that are subjective or unmeasureable. It is also understood that those who determine s~gnif,cance may have little or no format knowledge of the environment or may not be technically expert in environmental analys~s Inadd~ti~n~manywhohavekn~wIedgeinoneparticularareamaYnotbeawareofthebroaderconcernsaffectmg the question of significance. The full E^F is intended to provide a method whereby app!i.cants and agencies can be assured that the determination process has been orderly, comprehensive in nature, yet flexible enough tq allow introductibn of information to fit a project Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and information about a given project and its site. By identifying basic project data, it assis~ a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on Identifying the range of possible impacts that may o¢cur from ;s project or action. It provides guidance as to whether an impact is likely to be considered small ~o modera~:e or whether it is a potentially- · large ii~pa¢~ 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 whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE--Type I and Unlisted Actions Identify the Portions of lEAF completed for t,his project: F-I Part 1 [] Part 2 [Z]Part 3 Upon review of the information recorded on this EAF (Parts 1 and 2 and 3 If appropriate), and any other supporting information, and considering both the magnitude and Impo/tance of each Impact, it is reasonably determined by the lead agency that.: [] 4,. The project will not result in any large and important Impact(s) ~nd, therefore, Is one which will not have a significant Impact on the environment, therefore a negative declaration will be prepared. E) B. Although the project could have a slgnlflcant effect on the environment, there wlll not be a ~ignlficant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration ~dll be 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 wtll be prepared. · A Conditioned Negative Declaration Is only valid for Unlisted Actions Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Preparer (I f different from responsible officer) Date PA,,. 1--PROJECT INFORMATION Prepared by Project Sponsor NOTICE. This document is designed to assist in determining whether the action proposed may have a significant effect on the environment. Please complete the entire form. Parts A through E. Answers to these questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any additional information you believe will be needed to complete Par~ 2 and 3. It is expected that completion of the full EAF will .be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAM~ OF A~p~ICAHT~ONSOR ' ' BUSIHESS TELEPHONE STATE I ZIP CODE · I 19 q I1 fete3? BUSINESS TELEPHONE ( ) Plea,~ Complete Each Qu~tlon--lndlcate N.A. If not applicable Site Description Physical setting of overall project, bot]~ developed ~nd undeveloped areas. 1. Present land use: [Orban l-Ilndustdal [~]Forest l']Agriculture 2. Total acreage of project area: APPROXIMATE ACREAGE Meadow or Brushland (Non-agricultural) Forested Agricultural (Includes orchards, cropland, pasture, etc.) Wetland (Freshwater or tidal as per Articles 24, 2S of ECL) Water Surface Area ~Commerclal I~O~er acres. ~ Resldentiai (suburban) u~/~T ~.R_ I= Et) t',tT []Rural (nomfarm) Unvegetated CRock, earth or fill) Roads, buildings and other paved surfaces Other (indicate type) 3. What is predominant soil type(s) on project site? a. Soil drainage: -~WelJ drained % of site [3Poorly drained % of site CgModerately well drained % of site b. If any agricultural land Is Involved, how many acres of soil are classified within soil group 1 through 4 Land Classification System~ N/A acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project stte~ ii-lyes ~No a. Wh~t is depth to bedrock~ . hl/A (in feet) 'l 2 ofthe NYS PRESENTLY AFTER COMPLETION acres ~ acres acres ~o acres acres C:~ acres t~ acres acres ~ '~ /,~ ~roximate percentage of pro~6 roject site with slopes: ~0-10% ~ % E}lO-1S% % O15% or greater % ~ro~ect substantially contiguous, to, Dr contain a building, site, or district, listed on the State or the National islets of Historic Places[ OYe~ ~No 7 ~s roject substantially contiguous to a site listed on the Register of National Natural Landmarks? ~Yes ~No ~ V, at is the depth of ~he water table? ~/A (in feet) 9 Is ire located over a primary, principal, or sole source aquifer? ~Yes ~No 10 C , hunting, fishing or shell fishing opportunities presently exist in the project area? ~Yes ~No 1; E ,es project site contain any species of plant or:animal life that is identified as ~:h}eatened or endangered? ~Yes ~No According to ~U~ AN E. L~N~ Identify each species . 12..~ ~ there any unique or unusual land forms on the project site? {i.e., c~iffs, dunes, o~:her geological formations} ~Yes ~No Describe N JA 13. Is the proiect site presently used by the community, or neighborhoc~ as an open space'or recreation area? [~Yes ~INo . If yes, explain h'/,R -: 14 I ~es the present site include scenic views known to be important to the community? ~Yes 15. 5t :ams within or contiguous to project, area: a. Name of Stream and name of River to which it is tributary A/,JA ~ 16. La es, ponds, wetland areas withid or contiguous to project area: a. Name ~.. (')/__1_ .'~,~r~'J_'~ b. Size (In ac,'es) 17. Is ~e site served by existing pbb!k: utilities? i~Yes E]No a) f Yes, does sufficient capacity exist to allow ~onnectton? [}Yes I""lNo b) f Yes, will improvements be necessary to allow connection? ~lyes ClNo 18. Is ne site located in an agricultural district certified pursuant to AgriCulture and Mttrkets Law, Article Se~ ion 303 and ~O47 [}Yes ~No 19. I~: ' ~e site located in or substantially contiguous to a Critical Er~,lrc~nmental Area designated pursuant t6 Article 8 of ~e ECL, and 6 NYCRR 6177 [~Yes eINo ' 20. Ha the site ever been used for the .d'isposal of solid or hazardous wastes? C~Yes [3No B. Pr loot Description 1. Phy~ :al dimensions and ~cale of project (fill.in dimensions as appropriate) f . a. 'oral contiguous acreage owned or controlled' by project sponsor b. roject acreage to be developed: .~.(4 acre's inlti.~lly; c. roject acreage to remain undeveloped ~/.4acres. ' ' d. e~gth of project, i, miles: j~(,~ (If approl~;i;te) e. the project is an expansion, indicate percent of ex, panslon proposed f. r umber of off-stre'et parking spaces existing _1"1!'4 ; proposed .. .' ' g. [aximum vehicular trips generated per hour .~!.~. · (upon'completion of h. residential: Humber and type of housing units: One Fa~mlly Two Family Muitlple Family Ul, -nately L E menslons (in [eet) of largest proposed structure j. L ~ear feet of front, age along a public thoroughfare prolect will occupy. Is~ 3 acres. acres ultimately. %; proje,:t)? Condominium height; width; ~,, fL length. 2. How much natural material (i.e., rock,-earth, etc.) will be removed from the site? 3 W,II d,sturbed areas be reclaimed? DYes l/No ~]N/A a If yes, for what intended purpose is the site being reclaimedi' b. Will topsoil be stockpiled for reclamation? DYes ViNo c Will upper subsoil be stockpiled for reclamation? DYes [3No 4 How many acres of vegetation [trees, shrubs, ground covers) will be removed-from site? ' --~ - acres. $. V,'~II any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? ViYes i~No 6. If single phase project: Anticipated period of construction ON ~. 7. if multi-phased: a Total number of phases anticipated GN~. (number). b Anticipated date of commencement phase 1 month c. Approximate completion date of final phase month d. Is phase 1 functionally dependent.on subsequent phases? C/Yes DNo g. Will blasting occur during construction? DYes ~No 9. Number of jobs generated: during construction . ~ .; after project is complete. 10. Number of jobs eliminated by this project .... -o~ . 11. Will project require relocation of any projects or facilities? DYes 12. Is surface liquid waste disposal involved? DYes I~No a If yes, indicate type of waste [sewage, Industrial. etc.) and amount b. Name of water body into which effluent will be discharged ~v lA 13. Is subsurface liquid waste disposal Involved? DYes DNo Type 14. Will surface area of an existigg'.water body increase or decrease by proposal? Explain ~J.,~ 15. Is project or any portion of project located in a 100 year flood plain? r'lyes 16. Will the project generate solid waste?' DYes ~No a. If yes. what is the amount per month N'IA tons b. If yes, wilt an existing'solid waste facility be used? DYes E~'No c. If yes, give name . /,/lA ; location d. Will any wastes not go into a sewage disposal system or into a sanltaW landfill? e. If Yes, explain IliA months. (including demolition). tons/cubic yards year, (including demolition) year. ~ I~No If yes, explain DYes 6aND OYes ~No VINo 17. ','/ill the project involve the disposal of solid waste? a. If yes, what is the anticipated rate of disposal? b. If yes, what is the anticipated slte life? t4 ~A '1 '18. Will project use herbicides or pesticides? DYes DYes ~No N !.,4' tons/month. years. ~No 19. ¼'ill project routinely produce odors [more than one hour per day)? DYes I~No 20. Will project produce operating noise exceeding the local ambient noise levels? DYes 21. Will project result in an increase in energy use? ~Ye~ If yes , indicate typ~s) water supply is from wells, Indicate pumping capacity .N./A gallons/minute. 22. If 23 Total anticipated water usage per day ~./A · gallons/day· 24. Does project involve Local, State or Federal funding? [3Yes ]~No I~ Yes, explain ~No -/ Required: Town. v,llage Board OYes ~No Town. Village Planning Board OYes ~o Cd, Town Zoning Board OYes ~,~o Crl~ CounW Health Department I~Yes ~No Oth Local Agencies ~es ~No Otb, Regional Agencies ' ~Yes 5ta[~ Agencies Fade ,[ Age~ctes ~es ~No SubmiIIal Type Date C. ~_ )ning and Planning Information I D ~s proposed action involve a planning or zoning decisionl (~Yes 1 Yes, indicate decision requited: [zoning amendment I~zoning variance ~special use permit Osubdivision Osite plan []new/revision of master plan ~)resourc'e management plan Oother , 2 W~ ~t is the zoning ciassification(s)of the site? IRS..~I_%~T? h,L 3 WF t is the maximum potential development of the site if developed as permitted by the present zoning[' t 4. Wh t is the proposed zoning of the sltel 5. Wh, is the maximum potential development of the site if developed as permitted by the proposed zoningS' 6. is tk proposed action consistent with the recommended uses in adopted local land use plans? [~Yes C]No 7. Wha are the predominant land use(s) and zoning classifications within a ~ mile radius of proposed action~ 8. ts th proposed action compatible with adjolnlng/surroundin~ land use~ within a ~ mile? [~Yes 9. If tb proposed action is the subdivision of land; how many lots are proposedi' t. What is the minimum lot size proposed{ /J 10. Will ~roposed action require any authorization{s) for the formation of sewer or water districL~t ~Yes ~No 11. Will he proposed action create a demand for any community provided services (recreation, education, police, fire [ 'otection)~' ~¥es Ii~ yes, is existing capacity sufficient to handle projected demand? ~Yes ONo 12. Will ~ ~e proposed action result in the generation of traffic significantly above present Jevelsl [Yes z If yes, is the existing road network adequate to handle the additional traffic;' ~Yes [~No D. Infor ~atlonal Details Attad any additional information as may be needed to clarify your project. If there are or may be any adverse impac~ as )ciated with 'your proposal, please discuss such impacts and the measures which you propose to mitigate o~ avoid ~herr F_ Verlfl, atlon I certlf that the information provided above is true- to the best of my knowledge. If the actlon ~ntheCoastalArea,and~eastate~gen~c~mp~e~etheC~as~a~AssessmentFormbeforepr~c~ed~ng wtlh this ~s ~sment.