HomeMy WebLinkAboutTR-6011Robert DeFrese
5223 Indian Neck Lane
Peconic, NY 11958
February 28, 2005
Edmund Baumann
325 Wood Lane
Peconic, NY 11958
RE: 1000-86-6-3.2 & 2.2
Monuments
Dear Mr. Baumann,
IlAR - 1 2005
Snutlmld Town
Board of Trustees
I am in receipt of your letter dated January 24, 2005 in which you make demands to settle the issue
of our inadvertent encroachment onto your premises.
To date, the hay bales and black plastic fencing material (that were placed there pursuant to a
request from the Town of Southold Bay Constable in order to comply with the Violation Notice)
have been removed.
I am seeking further information from you in response to your demand for payment for the three
monuments you had installed on your property. Prior to agreeing to make any restitution for these
monuments I would like to review a copy of your survey showing that the monuments you claim
were damaged by me/my landscaper were placed in exactly the same location that they were prior
to this incident. I will notify you within 14 days of my position in this matter upon receipt of a copy
of your survey.
Your final demand was that I "don't ever again trespass" on your property. In accordance with this
request, I am also requesting that you never again trespass on my property without seeking
permission first.
Should you have any questions or comments, please feel free to contact me.
ROBERT DE FRESE
Cc: Ms. Lori Hulse Montefnsco, Assistant Southold Town Attorney
Members of the Board of Trustees of the Town of Southold
Nu-Green Landscaping
/
RESOLUTION
RESOLVED that the Board of Trustees of the Town of Southold hereby finds that the
application of EDMUND J. BAUMANN more fully described in the public hearing item #1
of the Trustee agenda dated Monday December 20, 2004, is classified as a Type II
Action pursuant to SEQRA Rubes and Regulations, and is not subject to review under
SEQRA.
Tetrault! Heather
From:
Sent:
To:
Cc:
Subject:
Corcoran, Kieran
Wednesday, December 01,2004 10:47 AM
Tetrault, Heather
Finnegan, Patricia
Baumann
Heather: ~ann s
I've spoken to Pat on this matter and we agree that Mr. hould be asked whether he would like to be heard at a
public hearing on his concerns, or stand on his letter. If he wishes to be heard, the hearing should be reopened for that
limited purpose, and to consider his letter. We also agree that a hold should be put on the oustanding permit in the interim
while this snafu is cleared up and the Trustees consider the additional substantive issues.
Let me know if you need anything else.
Kieran
Albert J. Krupski, President
James King, Vice-President
Artie Fester
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
November 29, 2004
Mr. Robert De Frese
5223 Indian Neck Lane
Peconic, NY 11958
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
RE: Ed Baumann wetland permit
Dear Mr. De Frese:
The Trustees are in receipt of your letter of November 18, 2004. We have forwarded this
matter to the Town legal department. They will determine what needs to be done under
Chapter 58, Notice of Pubic hearing.
Thank you for bring/ng your concerns on this matter to our attention.
Please contact the Town Attorneys, Pat Fixmegan or Kieran Corcoran regarding the
resolution of this matter.
Sincerely,
Heather Tetrault
Environmental Technician
Cc: Kieran Corcoran
Robert De Frese
5223 Indian Neck Lane
Peconic, NY 11958
631-734-2709
ECEO 'iE
NOV 1 9 2O04
November 18, 2004
Town of Southold
Board of Trustees
PO Box 1179
Southold, NY 11971-0959
RE: Property of Ed Baumann
Permit No. 60-11
Dear Sir or Madam,
I am writing this letter to voice my concerns regarding the above-referenced p,mdt that was issued
to my neighbor, Ed Banmann, whose property abuts my property to the west.
I am concerned about the work Mr. Baumann plans for his property for many masons. It is my
understanding that neighbors are to be advised by certified mail as to plante for these types of
property renovations. I was never advised in written or any other form as to the changes planned
for this property. Had notice been given, my concerns would have been voiced in a timely manner.
I am concerned about the environmental affects the renovations Mr. Banmann has planned for this
property will have on the wetlands abutting both our properties. The above-referenced permit was
issued for boat and trailer storage on property that runs along wetlands. This boat will undoubtedly
be leaking gas and oil into the ground that will seep into the wetlands. This is a concern for me.
The permit was issued for boat and trailer storage. What is to stop Mr. Baumann from storing other
vehicles (which also leak gas and oil) in this very same area?
I urge you to review your decision to allow for this renovation and also to take into consideration
the affects this type of storage will have on the environment. I am sure if you look into it, you will
see that the consequences of this type of property renovation will be detrimental to the enviroment.
I thank you in advance for your time and anticipated cooperation in this matter.
Sincer~y,
se~
RD/rtz
Robert De Frese
5223 Indian Neck Lane
Peconic, NY 11958
631-734-2709
NOV 1 9 2004
Southold Tow.
Board of Truste~
No~ember 18, 2004
Town of Southold
Board of Trustees
PO Box 1179
Southold, NY 11971-0959
RE: Property of Ed Baumann
Permit No. 60-11
Dear Sir or Madam,
I am writing this letter to voice my concerns regarding thc above-referenced permit that was issued
to my neighbor, F_xt Baumann, whose prope~y abuts my property to the west.
I am concerned about the work Mr. Baumann plans for his property for many masons. It is my
understanding that neighbors are to be advised by certified mail as to plans for these types of
property renovations. I was never advised in written or any other form as to the changes planned
for this property. Had notice been given, my concerns would have been voiced in a timely manner.
I am concerned about the environmental affects the renovations Mr. Baumann haa planned for this
property will have on the wetlands abutting both our properties. The above-referenced permit was
issued for boat and l~ailer storage on property that runs along wetlands. This boat will undoubtedly
be leaking gas and oil into the ground that will seep into the wetlands. This is a concern for me.
The permit was issued for boat and ~ailer storage. What is to stop Mr. Baumaun from storing other
vehicles (which also leak gas and oil) in this very same area?
I urge you to review your decision to allow for this renovation and also to take into consideration
the affects this type of storage will have on the environment. I am sure if you look into it, you will
see that the consequences of this type of property renovation will be detrimental to the environment.
I thank you in advance for your time and anticipated cooperation in this matter.
Sincerely,
~se
RD/rtz
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
December 20, 2004
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. Edmund J. Baumann
325 Wood Lane
Peconic, NY 11958
RE: 325 WOOD LANE, PECONIC
SCTM# 86-0602.2,2.3
Dear Mr. Baumann:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Monday December 20, 2004:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit #6011 to remove trees and establish a rear property ddveway for trailer and boat
storage/access, and plant evergreens on the north property line with the condition there
will be no grading and no further cleadng within 100' of the water and with the condition
that the ddveway will be used for trailer/boat storage only, and all as on the plan
surveyed by Joseph Ingegno and approved by the Board of Trustees on Oct. 20, 2004.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK:hct
Albert J. Krupski, Presiden~
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
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. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
Ed~nd ~ann SCTM#86-6-$. 252.2
INSPECTION SCHEDULE
__ Pm-construction, hay bale line
__ 1st day of construction
~ constructed
XX Project complete, compliance inspection.
Board Of $outhold 'Town Trustees
SOUTHOLD, NEW YORK
ISSUED TO EDMUND BAUMANN
Pursuant fo the provisions of Chapter 615 of the Law~ of
the State of New Yodq 1893~ and C4tapter ~ of the Law~ of ~he
State of New Yor~ 19S2: and the Sobthokl Te~n Ordinance ea-
~fled:!'RE~UI~TIN~-AND THE- ~C, IN~.OF
IN AND ON TOWN WATERS AND PUBLIC LANDS and'the
REMOVAL OF SAND, GRAVEL-OR OTH.ER MATERIALS. F~LOM (;,/
LANDS .UNDER TOWN'WATERS~E and In a~',co~la~me wlfh '~e
Resduflon of The Board ,,dopted at a meeting held on ..0.....~..........~ ....... ~. ~.
.~O.~..4....L, and in cqnsklerafion of the sum of $.~.~L..~.~ .......... paid by
.......... ~:d.,~ ~...~ a~,~.,,~ ............................................................................ ].._.: ...................
..t Pe¢o~Le ' ' N.Y. nd ee to
,,, ....................................................................................... a .~bI t 'the/ '
Terms and C, ond~ons tided on the reverse side hereof/
of Southdd Toxin' Trudees authorizes and permlh fl~ following:// ~ ~' .. .
~]et~z~nd Pe~u~it to remove races and establish ~ roa~ ~. ~,' ~"'~ ' k'
ert~ d~ivewa~ .for t~i~er and boat storage/access and-~a~~-
~rv~¢~e~-~-Td~'e~P~r~';[~igno ~nd approved by the Bo~u/ o~ Tru~tee~I ~. c.
u~. ~o, ~f~rrNEss WHEREOL T~ .~ BO~d ~f Tn~.~ im~
by ceuses its _C~)rporate. Seal to be aff'~nd, end ~hese prese~h fo
b~ subseribnd by b'melorl~y of fhe sald Board .as of ~s d~s,
5. Ti~t ~ P~. * dmuld be ~ indefln~ly, ~ a~ ~ e~ t~e sdd Pemslm~ wid~ '
revocttlon of ~ ~ By tesohdon o~ the said
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095Route 25
P.O. Box 1179
Southold, New¥ork 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
October 20, 2004
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. Edmund J. Baumann
325 Wood Lane
Peconic, NY 11958
RE: 325WOOD LANE, PECONIC
SCTM#86-6-3.2&2.2
Dear Mr. Baumann:
The Board of Town Trustees took the following action dudng its regular meeting held on
Wednesday, October 20, 2004 regarding the above matter:
WHEREAS, EDMUND J. BAUMANN applied to the Southold Town Trustees for a
permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland
Ordinance of the Town of Southold, application dated September 27, 2004, 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 20, 2004, 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 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 approve the application of EDMUND J.
BAUMANN to remove trees and establish a rear property driveway for trailer and boat
storage/access and plant evergreens on the north property line, with the condition that
there will be no grading and no further clearing within 100' of the water, and all as
depicted on the plan prepared by Joseph Ingegno and approved by the Board of
Trustees on October 20, 2004.
Permit to construct and complete project will expire two years from the date the permit
is signed. Fees must be paid, if applicable, and permit issued within six months of the
date of this notification.
Inspections are required at a fee of $50.00 per inspection. (See attached schedule.)
Fees: $50.00
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/hct
Telephone
(631) 765-1892
Town Hall
53095 Route 25
P.O, Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Monday,
October 18, 2004, the following recommendation was made:
Moved by Don Wilder, seconded by William Cook, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the Wetland Permit application of EDMUND J. BAUMANN to remove
trees and establish a rear property ddveway for trailer and boat storage/access and
plant evergreens on the north property line. Located: 325 Wood Lane, Peconic.
SCTM#86-6-2.2&3.2
The CAC recommends Approval of the application with the Condition that (~nly the
selected trees on the attached survey are removed and the trees within 30'of the
wetlands, on the north property line, east of the wetlands, should remain.
Vote of Council: Ayes: All
Motion Carded
-j
', L
?
?
"i
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
Office Use Only
Coastal Erosion Permit Application
_~--'~etland Perm/t Application ~'-Major
__Waiver/Amendme~/Cla~ges
~/~eceived Applicatio~~
,..C~rrapleted Apph'%ation
Incomplete
· SEQRA Classification:
Type I Type H Unlisted
Cooraination:(date sent)
~ Referral Sent:.~.~
,Date of Inspection:
Receipt of CAC Report: ~ '
Lead Agency Determination:__
Technical Review:
Resolution:
Minor
SEP 2 7 3~04 ,.~
Name
Addr, s
Phone Number:(
Suffolk County Tax Map Number: 1000 -
Prove~ Location:~
(provide LILCO l~ole #[ distance to cross streets,
AGENT: ~-
Clfapplicable)
Address:
Phone:
Board of Trustees Application
GENERAL DATA
Land Area (in square feet):
Area Zoning:
Previous use of property: .~,~ I /9~ r/ff't-
Intend~l use of property:
Prior permits/approvals for site improvements:
Agency Date
__ No pfio~ pe~'m~ts/approv~ls ~or site improvemems.
Has any permit/approval ever been revoked or suspended by a governmental agency?
)(3 No Yes
Ii'yes, provide explanation:
Project Description (use attachments if necessary): [ fiLS
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:~l~~~~
Area of wetlands on lot: ~ lO00 square feet
Percent coverage of lot: ~ I %
Closest distance between nearest existing structure and upland
edge of wetlands: ~ ~ O0 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~ I tO feet
Does the project involve excavation or filling?
No Yes
If yes, how much material will be excavated? 0 cubic yards
How much material will be filled? ~1 cubic yards
Depth of which material will be removed or deposited: 0 feet
Proposed slope throughout the area of operations: '-----
Manner in which material will be removed or deposited: ~
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:~~~~t~
Are wetlands present within 100 feet of the E_mposed activity9
No ~'~ Yes
Does the project involve excavation or filling?
~ No Yes
If Yes, how much material will be excavated? ~
How much material will be filled? o
Manner in which material will be removed or deposited:
(cubic yards)
(cubic yards)
0
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
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 11971-0969
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ~~~12~esiding at ~~2~L~
being duly sword, depose and say:
'rhat on the ~ day of ~ , 24, ~ pers°nally posted the prop~ ~o~ ~
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for ei
· :1~ days prior t~Mi~e date of the public
hearing. Date of hearing noted thereon to be held I . , ~'
Dated:
/(signature)
Sworn to before me.thtis
ANGELA LOCORRIERE
Notary p. ublic, State of New York
~o. 01LO6068050
Qualified in Suffolk Cmmtv
Commission Expires Oct.
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
Iu the matter of app=licant: ~ /~t~)~l/# ',~- ~//-t~,v,~n~__
SCTM#
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a Permit from the Board of Trustees
your property and is described as follows:
3. That the project which is subject to Environmental Revie..~ under Chapters 32, 37, end/or
97 of the Town Code is open to public comment on: (~,]OJ~a'~,tOaO!e~O~)le~ {-/ . 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.
MAILINGADDRESS.~ ~Z_$ t~t9 ~
PHONE #:
Enc: Copyofsketchor plan showing proposal for your convenience.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
N~kl~e:
Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
being duly sworn, deposes and says th.'t 6n th~ '
· ,g' day of~ 20o'~, deponent mailed a true copy of the Notice ·
set forth, in the Board df Trustees Application, directed to each of the aboye 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; *hat said Notices were mailed at the United States Post
Officeat ~..c~UW.~- ! ~Y , that said Notices were mailed to each of said persons by
(certified) (registered) mail.
Sworn [~,befgre n~e this ' ;~
2oOq.
--
Board of Trustees Application
County of Suffolk
State of New York
D/-Ei~-~!.~.p/ J'- ~:~, ~l~l~'J~ BEmGD~YSWO~
OSES ~ ~F~ T~S~ IS ~ ~PLIC~ FOR ~ ~O~
DESC~ED PE~T(S) ~ ~T ~L STA~S CO~ ~ ~
~ TO ~ BEST OF ~S~R ~O~GE ~ BEL~F, ~ ~T ~L WO~
~L BE DO~ ~ T~ ~R SET FOR~ ~ ~S ~PLICATION ~ ~ ~y
BE ~PRO~D BY ~ SO--OLD TO~ BO~ OF ~US~S. ~ ~PLIC~
AG~ES TO HO~ T~ TO~ OF SO--OLD ~ ~ TO~ ~US~S
~SS ~ ~E ~OM ~ ~ ~ D~S ~ CL~S ~S~G
~ER OR BY ~ OF S~ P~(S), · ~. ~ CO~T~G ~S
~PLICA~ON, I ~BY A~O~ ~ ~US~S, ~ AG~(S) OR
~8E~ATI~S(S), TO E~ O~O ~ PROP~TY TO ~SPECT ~
P~SES ~ CON~CTION ~ ~W OF ~S ~PLICA~ON.
SWORN TO BEFORE ME THIS_~
APPLICANT/AGENT/RF_,PRF_~ENTATIVE
TRANSACTIONAL DISCLOSURE FORM
Tlg Town of Son~old'[ Code of Ethics orohibits conflicts of interest on the hart of town Office~ and emnlovans. Thc oumos~ ~'
this form is to ~rovlde infotmntion which cnn siert the town of~ncsible conflicts of h~e~st and nilow it to teko whn~ver action is
(Last name, tim nnme~,i~3ddfe Iniflsi, tmless y~u nrc applylog in the nam~ of
anmeone else or other entity, such as a company. If so, indica~ ~e other
person's or coml~ny's name.)
NAME OF APPLICATION: (Check si! that apply.)
Tax g~ievance Building
Vadance 'l'mstee
Change of Zone Coastal Erosion
Approval of pint Mooring
Exemplton from plat or official map Planning
Other
(If"O~er~, name the activity.)
Do you personally (or thmngh your comt~ny, spouse, sibling, pssant, or child) have a ~lalionship with any officer or employee
of the Town of Southold? "Relationship" includes by blood, marti~e, or business ~ "Business ~ means a business,
including a pertnership, in which the town o flip:er or c-mployee has even a p~tlnl ownership of(or employment by) a corporalion
in which the lown officer or employee owns more than 5% of the situses.
YES ~ NO
If you answered 'YES", complete the I~lance of this form and date and sign where indicated.
Name of person employed by the Town of Southold ~ ~0 ~-I g.~
De'~ribe ~ae relationship betw~n yourself (tl~ applicant/ngenthvl~e~ntative) and the town officer or employee. Either check
the appmpri~e line A) through D) and/or desaibe in the space provided.
The ~vn officer or employee or his or her spouse, sibling, parent, o~ Chihi is (check all tlmt a~ply):
DESCRIPTION OF RELATIONSHIP
Form TS I
Submitted Ih~ ~..~dny of ~F-.4~'~. 200 __~
Print Nnme - ~.
PROJECT ID NUMBER
.
I
.
1. APPLlCANT-i.SF af JGeR.
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
(To be completed by Applicant or Project Sponsor)
2. PROJECT NAME
SEQR
PART 1. PROJECT INFORMATION
/\I
"",1bolI N -
3.PROJECT LOCATION:
Municipality Jt>
t...1J
County
S u/FO
4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ate - or provide map
325' LJOo.1J t.ANE
Ii:-
IVy
5. IS PROPOSED ACTION: D New
D Expansion [8bMOdifiCatiOn / alteration
6. DESCRIBE PROJECT BRIEFLY:
CD ~~~~l,~~~-~
jtrt ~ It- --t-oJ S~ /o..CU-./4
@ ~~~J~~c1~~)3~~Pr
~ ~ 01 ClAz-~ ~,.I. ...1
..J- d ) ~J
u-r~ ~
7. AMOUNT OF LAND AFFECTED:
Initially.' acres Ultimately . I acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~ Yes D No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY
[pJ Residential D Industrial 0 Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture D Park I Forest I Open Space
D Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal. Slate or Local)
DYes ~ No If yes, list agency name and pennit I approval:
11. DOES
DYes
ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR
~ No If yes, list agency name and permit I approval:
APPROVAL?
PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Si nature
Date:
Applicant
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
.
.
PART II - IMPACT ASSESSMENT (To be eomoleted bv Lead Aaenevl
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review p!ocess and use the FULL EAF.
DYes DNo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
DYes DNo .
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid wasle production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
I 1
- --..- --.- I
I
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
I I
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
I I
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly:
I I
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
L . .......~... - I
C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I I
C7. Other impacts (includina chanoes in use of either nuantitv or tvne of enernv? Exnlain brieflv:
I I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (Ifves, explain briefly: I
DYes 0 No I
E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: I
DYes DNo I
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 with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e)
geographic scope; and (1) 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 jj was checked
yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
Check this box if you have identified one or mOre potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL
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 actio
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi
determination.
Name of Lead Agency
Date
Pnnt or Type Name of ResponsIble Officer In Lead Agency
Title of Responsible Officer
Signature of ResponsIble Officer in Lead Agency
Signature of Pre parer (If different from responsible officer)
.
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10/13/04 Field Inspection.
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