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Home My WebLink AboutTR-5238 ·.... ,- '¥ ;~. " /-\" TERMS and CONCmONS The Permittee ELLEN A. GROPPE residing at 180-44 Grand Central Parkway, Jamaica Estates N. Y.. as part" of the consideration for the issuance of the Permit does DDderscand and pœsaibe to the fol- løwiøg: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arlsiag ditecdy or loditecdy IS a <aWt of any opec- &don performed punuant to this pemñt, and the said p.rmi_ will, at his or her own expense, defend any and all such snits" initiaœd by third parties, and the said Permittee _ £aI1liability with respect thereto, to the complete eo:dusion of the Board of TtuSteeS of the Town of ~1d 2. That this Petmit is" valid for a period of 24 mos. which is considered to be the escimated time" cequited co complete the wet!< involved, but shonld cUaumtaDCeS wmsnt, request for an extenSion may be made to the Board at a later date. 3. That chis Permit should be retained indef"lI1Ítely, or as long as the said Petmittee wishes co maintain the 5tIuctl1te or project involved, to provide evidence to anyone con=ned that auth- orization was originally obtained. 4. That the work involved will be subject to the inspecciOD and approval of the Board or its agents, and non-compliance with the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the wotk herein autborized. 6. That there shall be DO interference with the right of the public co pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southald require the removal and/or alteradoøs in the location of the wot!< herein aulhorized, or if, in the opinion of the Board of Trascees, the " wotk shall cause unreasonable OOsttuctIOD to free navigatioa, the said Peanittee will be required, upoo due notia; to remove or alter this wet!< or project herein stated without ezpenses to the Town of Southold. 8. That the said Board will be notified by the Permittee oc the completion of the wotk mth. orized. 9. That the Permittee will obtain all other permits and consents that may be required sup; plemenca1 to this permit which may be subject to revoke upon fa11uœ to obtain ume. ...~.~, . ~, . ~ _;;'4<.:. '\ \ ','; ""' ... ," . . ELIZABETH A. NEVILLE TOWN CLERK Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's Office. (agency Freedom of Information Officer). One copy wil' be returned to you in response to your request, or as an interim response. ---------_____________________________0_______________________________________ ---------------------------------------- --.----------------------------------- SECTION I. ......- i I ~I I you are requesting.) TO: (Department or Officer, if known, RECORD YOU·'WISH TO INSPECT: (Describe the record sought. If possible, date, file title, tax map number, and any other pertinent information,) ( + ~1; 1-1.j VVì.', In U~Jì ~ -?, - I L (+hß.tJ';~ ~:v:u-4, ) 3 IS (/ L~~ 11,'1 /VI/n. w·/.:> ) ') ! OVu - D 3 1)("';- L () ~ i" . . r~-L.,' { , ~^--- Signature of Applicant: " ( .:c::-J= /~,-/.~",-__C v"-"·----'"_ -- Printed Name;""-~rn~ n A~¿--- ~~ /1 11. (k Address: ?t ') c¡ g;jx1- rð {¿, rt-.. S+ 4=- (ð 7<.. ) I supply I O?) () - s:-:s } ()V) - S-3 s - 10 I (Joo - :;-5 Mailing Address (if different from above): Telephone Number: 2.1.l---~.3~- ~02./Date: JJiC . ~/ /?;/~ I (rJUlf ======================--============================================================= [ [ ] ] APPROVED APPROVED WITH DELAY* qECEIVED [ ) DENIED* NAY 1 8 2001 ~~ Eli .. vi e" Freedom f Information Officer ...",nO,Q {Own Clerk Date * If delayed or denied see reverse side for explanation. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . . Town Hall 53095 Route 25 P.O. Box 1179 :<'",lh',:<1. New York 11971-0959 r Telephone (631) 765-1892 ~ax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 25, 2002 Mr. Matt D. Ivans Suffolk Environmental Consulting, Inc. P.O. Box 2003 Bridgehampton, NY 11932-2003 RE: 1085 Bayshore Rei., Greenport SCTM#53-3-12 Dear Mr. Ivans: . The following action was taken at the Southold Town 80ôrd of Tr"u;;tees regular meeting held on Wednesday, April 24, 2002: RESOLVED, that the Southold Town Board of Trusiees APPROVE the request for a Transfer of Permit #5238 from Ellen A. Groppe to Robert E. & B&rbara C. Holley. If you have any questions, please contact our office at (631) 765-1892 Sincerely, (l:.LJ (}. /¿"_('~&.' Çt.. Albert J. Kru6ski, Jr. President, Board of Trustees AJK:lms . . Albert J. Krupski, Pl'esident James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Te!ephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 30, 2000 Mr. Matt D. Ivans Suffolk Environmental Consulting, Inc. P,O. Box 2003 Bridgehampton, NY 11932 Re: ELLEN A. GROPPE 985 BAY SHORE RD., SOUTHOLD SCTM#53-3-12 Dear Mr. Ivans: The following action was taken by the Board of Town Trustees during its regular meeting held on October 25, 2000 regardiag the ~bove matter: WHEREAS, Suffolk Environmental Consulting, Inc. on b~ha~f of ELLEN A. GROPPE applied to the Southold Town TruRtees for a permit under the provisions of the Wetland Ordinance of t.he Town at Southold, application dated August 21, 2000. and 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 respect to said application on October 25, 2000 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 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 standards set forth in Chapter 97 of the Southold Town Code, . . WHEREAS, the Board has determined that will not affect the health, safety and people of the town, the project as proposed general welfare of the NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of ELLEN A. GROPPE to construct a single-family dwelling, driveway, and septic system. The 24'X 36' proposed dwelling is to be built on piles and located 47'+/- from the wetlands with a 40' non-disturbance buffer adjacent to the tidal wetland line, all with the condition that there be no turf and no fill placed on the north or on the west side of the house or on the west side of the proposed driveway, and no fill or turf on the east side of the house. The only fill that will be brought in will be for the septic system on the south side of the house. Native species should be planted after construction and that ther9 be a staked row of hay bales at the 40' non-disturbance buffer line during construction. 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. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. Fees: None Very truly yours, a.YL,19· I~~'~' Albert J. Krupskl, Jr. President, Board of Trustees AJK/lms cc: DEC Building Dept. . . Telephone (516) 765-18"12. Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, September 12,2000, the following recommendation was made: Moved by Ken Meskill, seconded by Scott Hilary, it was RESOL VED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit Application of ELLEN A. GRQPPE 53-3-12 to construCt it single~rànìilY·· """_~""_-é.n . ,~.,...-."-.,- . dwelling, driveway, and septic system. The 24'X 36' proposed dwelling is to be built on piles and located 47'+/- from the wetlands. A 40' non-disturbance buffer is proposed adjacent to the tidal wetlands line. Previous Permit #4754 expired. 985 Bay Shore Rd, Southold T.!f CAC recommends Disapproval because of the inadequate setbacks and question ··inadequacies on the survey regarding the distances on survey from the edge of wetlands'to the . prppo~ed stfljcture. Vote of Council: Ayes: All Motion Carried , . Suffolk Environmental Consulting, Inc. Newman Village. Main Street. P.O. Box 2003, Bridgehampton. Ne\\ York 11932-2003 (631) 537-5160 Bruce Anderson, M.S.. President Fax: (6111537-5198 August 15,2000 Mr. Albert 1. Krupski, President Town Hall P.O. Box 1179 Southold, NY 11971 ALIG 2 I "-GI' Re: Groppe property . Situate: qffŠ Bay Shore Road;Southold, NY SCTM #: <-/' 1000-053-03-012 Dear Mr. Krupski, This Firm represents Ellen A. Groppe who is seeking improvements to the above referenced property. In order to do so, a Wetland Permit ftom your Board is required. Enclosed herewith please find a completed Wetland Permit Application. Application contents are as follows: (I) Town of South old Trustees Wetlands Permit Application; (2) Short Environmental Assessment Form; (3) Two surveys prepared by Joseph A. Ingegno, Land Surveyor, showing all proposed structures and tidal wetlands; and (4) Check made payable to the Town of South old in the amount of$150.00 covering the requisite application fee. By way of this correspondence, I request that you commence review of this application. Thank you in advance for your cooperation. enc. cc: C. Groppe Suffolk Environmental Consulting, Inc. Newman Village, Main Street. P.O. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5198 Bruce Anderson, M.S., President April 10,2001 Mr. Albert 1. Krupski, President Town Hall P.O. Box 1179 Southold, NY 11971 APR I 6 2001 -, I ' . I II ...,' ,j . L__ SCTM #: Groppe property Bay Shore Road Southold, NY 1000-053-03-012 Re: Situate: Dear Mr. Krupski, As you know, this Firm represents Ellen A. Groppe who is seeking improvements to the above referenced property. On August 15, 2000, this office submitted an application for a Wetlands Permit trom your Department, which was subsequently approved upon certain conditions. One such condition was for the establishment of a "No Turf' zone along the west side of the proposed driveway, and along the west, north and east side ofthe proposed dwelling. Enclosed herewith please find: (I) Survey of the above referenced property, prepared by Joseph A. Ingegno, L.S., last revised March 30, 2001, indicating the "No Turf' zone as per your Department (four [4] prints). Kindly review the enclosed item and issue the requested Wetlands Permit to this office. Should you have any questions regarding this matter, please feel tree to contact this office at any time. Thank you in advance for your cooperation. L r Matt D. Ivans enc. cc: C. Groppe . . Suffolk Environmental Consulting, Inc. Newman Village. Main Street. P.O. Box 2003, Bridgehampton. New York I 1932-2003 (63l1537-5160 Fax: (6311 537-5198 Bruce Anderson, M.S.. President Hand Delivered March 28, 2002 Mr. Albert 1. Krupski, President Board of Town Trustees Town Hall P.O. Box 1179 Southold,NY 11971 ) ~_ W Re: Groppe to HolI ~ n.f'lr - { ~ ~. /)~ Situate: 1085 Bayshore ~~'¿¡':::port, NY SCTM #: 1000-053-03-012 " Dear Mr. Krupski, This Finn represents Mr. and Mrs. Holley who have recently purchased the property referenced above fÌ'om Ellen A. Groppe, and subsequently merged said property with his own property, and wishes to transfer all previously secured approvals concerning subject property into his name in order to improve thereon. In order to do so, approval fÌ'om your Board is required. Attached herewith please find: (I) Copy of the Southold Board of Trustees Permit, dated October 30, 2000 (Permit No. 5238), issued to Mrs. Groppe, approving for the construction of a".. .single-family dwelling, driveway, and septic system... "; (2) Assignment by Ellen A. Groppe to the Board of South old Town Trustees concerning Permit No. 5238, dated November 27,2001; (3) Survey of the above referenced property, prepared by Joseph A. Ingegno, L.S., last dated February 18,2002, indicating the proposed improvements ofMr. and Mrs. Holley (two [2] copies); and (4) Check made out to the Town of South old in order to cover the requisite application fee. ,". ¿ 8 c.. Hammarthl . . 2 Please note that the initially approved project of Mrs. Groppe is identical in both size and scope to the project as proposed by Mr. and Mrs. Holley. By way of this correspondence, and on behalf of Mr. Holley, kindly transfer Permit No. 5238 rrqm Ellen A. Groppe to Robert E. & Barbara C Holley. Should you have any questions regarding this matter, or require additional information, please feel rree to contact this office at any time. Thank you in advance for your cooperation. Sincerely, ~¿ Matt D. Ivans r ~ enc. cc: R. Holley . . ASSIGNMENT I hereby assign all of my right, title, and interesl in and to Board of SOUlhold Town Trustees Permit No. 5238, dated October 30, 2000. Dated this 27"' day of November, 2001. IZIJ.., d ~ ELLEN A. GRÓPPE ¡'1M 2 \:I . ,-- -. - . Albert J. Krupski, President John Holzapfel, Vice President Jim King Martin H. Garrell Peter Wenczel Town Hall 53095 Main Road P. O. Box 1179 Southold, New York ll971 Telephone (63l) 765-l892 Fax (63l) 765-l823 Phone Number (212) 682-0020 Suffolk County Taxct:!t Number: 1000-053-03-012 Property Location:~ Shore Road; Southold, NY AGENT: Suffolk Environmental Consulting, Inc. Address: P.O. Box 2003 Bridgehampton, NY 11932 Address 180-44 Grand Central Parkway; Jamaica Estates, NY 11432 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use only Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application waiver/Amendme~Ch1ngeS Received Application: ~llrV Received Fee:~I5D _=if . / Completed Application f}../ J rV Incomplete I SEQRA Classification: Type I Type II Unlisted Coordination: (dat~e t)~ CAC Referral Sent: I rv Date of Inspection: h ..--- Receipt of CAC Report: Lead Agency Determination: Technical Review: ~ Public Hearing Held: ~ Resolution: x AUG 2 / L I.. I, t..'......._.. Name of Applicant Ellen A. Groppe (provide LILCO Pole #, distance to cross streets, and location) k \, \ ~. \ç. r""' . I- ~ \ \ \¥:\ ',' '( \. J r ().~ <l~: . ¡ ~y' .~'\ r(~· ¡ '.)J' t~."· r t Y: ,'" '\ : - '.1 , .... \ ..... Phone ~)~~ ~ 1'0' ',:\ \ c'", ~ Board of Trustees - . Application GENERAL DATA Land Area ( in square feet) : 18, 747.01 square feet Area Zoning: R - 40 Previous use of property: Unimproved vacant lot Intended use of property: Private single family dwelling Prior permits/approvals for site improvements: Agency Date July 15, 1997 (renewed) April 4, 1997 June 25, 1997 (expired) Suffolk County Dept. of Health NYSDEC Tidal Wetland Permit Southold Trustees Permit No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary) Applicant proposes to construct a single family dwelling, driveway, and septic system. The 24' x 36' proposed dwelling is to be built on piles and located 47' + from the wetlands. A 40' non-disturbance buffer is proposed adjacent to the tidal wetlands line. 2 ~ Board of Trustees - . Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: To construct a private single family dwelling with related appurtenances. Area of wetlands on lot: 7500 ± square feet Percent coverage of lot: 40 ± % Closest distance between nearest existing structure and upland edge of wetlands: n/a feet Closest distance between nearest proposed structure and upland edge of wetlands:47 feet Does the project involve excavation or filling: x No Yes If yes, how much material will be excavated? n/a cubic yards How much material will be filled? n/a cubic yards Depth of which material will be removed or deposited: n/a feet Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: n/a 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): No impact to the wetlands anticipated due to the project design and the existence of other adjacent similar structures which have not produced any apparent impact to the wetlands. 3 . Board of Trustees . Application COASTAL EROSION APPLICATION DATA Purpose of Proposed Activity: N/A Are wetlands present within 75 feet of the proposed activity? No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from the implementation of the project as proposed. (Use attachments if necessary) 4 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Ellen A. Groppe SCTM# 1000-053-03-012 YOU ARE HEREBY GIVEN NOTICE: 1. That is the intention of the undersigned to request a Permit from the Board of Trustess to: To construct a private single family dwelling with related appurtenances. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: Situated on the north side of Bay Shore Road, 962 feet east of Kerwin Boulevard; Southold, NY 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. 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 # Ellen A. Groppe 180-44 Grand Central Jamaica Estates, NY (212) 682-0020 Parkway 11432 Enc.: Copy of sketch or plan showing proposal for your convenience. 5 Board of Trustees Application County of Suffolk State of New York ELLEN A. GROPPE BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVE(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ¿" /ì U / þ.Þ~ ..( N SigIÍatu SWORN BEFORE ME THIS z y DAY OF :;;e~r 2000 {lc¿tL¿¿, /-ffztþ Notary Public /' ......C!f"RlESJ. GROF-F-ê: -, Pubfie, StaleofNewYalll No. 02GR1582600 Gull Qns. Co. CM. Flied in N.V QJ. Cornmiaion Expirea.ltln, 31, ~ 7 Board of Trustees Application AUTHORIZATION (where applicant is not the owner) I, ELLEN A. GROPPE residing at 180-44 Grand Central Parkway; Jamaica Estates, NY 11432, do hereby authorize Suffolk Environmental Consulting, Inc. (Agent) to apply for permit(s) from the Southold Board of Trustees on my behalf. ~j7~ tl_ ~ (Owner's signa re) 8 .- - 14-1~(9I95)-Text 12 I PROJECT I.D. NUMBER 617.20 I Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only SEQR /c.: c, PART 1- PROJECT INFORMATION I. APPLICANT/SPONSOR Suffolk Environmental Consultin Inc. 3. PROJECT LOCATION: Municipality Southold County Suffolk 4, PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc, or provide map) North side of Bay Shore Road 962 feet east of Kerwin Boulevard; Southold NY 5. IS PROPOSED ACTION: 181 New 0 Ex nsion 6. DESCRIBE PROJECT BRIEFLY: o Modification/alteration Applicant proposes to construct a single family dwelling, dreiveway. and septic system. The 24' x 36' proposed dwelling is to be built on piles and located 47' ± from the wetlands. A 40' non-disturbance buffer is proposed adjacent to the tidal wetlands line. 7. AMOUNT OF LAND EFFECTED: Initial! < 0.05 acres Ultimatel < 0.05 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? 181 Yes 0 No II No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 1:8] Residential o Industrial DCommercial DAgriculture Describe: OParklForest/Open space Oather Private single family dwellings. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT AGENCY (FEDERAL, STATE OR LOCAL)? o Yes 181 No II yes. list agency(s) and permitlapprovals II. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? 181 Yes 0 No If yes, list agency(s) and permit/approvals NY State Department of Environmental Conservation Tidal Wetlands Pennti (Dated April 4, 1997) Suffolk Count\' t. of Health Services ated Jul ' 15. 1997; renewed 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? o Yes 181 No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: Matt D. Ivans - uffolk Environmental Consultin Inc. Date: 08/02/00 Signature: -..- If the action is in the Coastal Area, and you are a stste agency, com plete the Coastal Assessment Form before proceeding with this assessment OVER PART 11- ENVIRONMENTAl ASSESSMENT (To be colT1Jleted bv Aaencv) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.12? If yes, coordinate the review process and use the FULL EAF. Dyes o No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.fr? If No, a negative declaration may be superseded by another involved agency. o Yes 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C 1, Existing air quality, surface or groundwater quality, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archeological, historical or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3, Vegetation or fauna, fish, shellfish or wildlife species, significant habitat, or threatened or endangered species? Explain briefly: C4, A community's existing plans or goals as officially adopted, or change in use or intensity of use of land or natural resources? Explain briefly: C5. Growth, subsequent 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 C1-C5? Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE I='ROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA? DYes DNo D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? DYes DNo If yes, explain briefly PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important, or otherwise significant. Each effect should be assessed In connection wrth Its (a) setting (I.e. urban 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. If question D of Part II was checked yes, the determination and significance must evaluate the potential Impact of the proposed action on the environmental characteristics of the CEA. o 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. o Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible Officer Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (if different From responsible officer) 2 -