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HomeMy WebLinkAboutTR-5760Board Of $outhold Town Trustees ISSUED TO ................... CAbl~AC.F....M.,..-GO[.I,~;.TT ................................... Pursuant to the provis;ons of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 40~ of the Laws of the · State of New York 1952; and the Soufhold Town Ordinance titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;'-.~. and in accordance with the Reselu~ion of The B~ard adopted at a meeting held on ........ ~.y..~.1.~ .ZC~0.~..., and' in consideration of the sum of $--?.00-,O0 paid by · gar~...H., .. C~le~.t ........................................................... : .................. of .....~.~.s~,~ ................... N. Y. and subject to the Terms and Conditions listed on the reverse dde hereof, of SoufhoJd Towa Trmfees authorizes and ~ermits the Wetland Permit to construct extensions and addit/ons [o ma existing single farmjy residence a 603.5 s.£ +/- covered porch is proposed with a new eatS, on the front of the existing residence a 745 */- addition is proposed on the north and east side of the existing residence 768 +/- s.f. of deck area is proposed on the east side of the residence a 216 +/- s.f. screened porch is proposed on the south side of the realdenee a 31'x22' (682 s.f.) detached garage is proposed south of the existing residence. Pervious earth driveway in front of residence and to access proposed detached garage- proposed structure to the wetlands line is the proposed deck, which is proposed to be setback 86 feet. With the stipulation of a hay bale line dining eonetrucfion at fifty foot back from the wetland line - drywells and gutters on the house on all of the extensions. IN WITNESS wl-lt:K~-, i~- ;a,a t~oera ot ,rusteos mr.- by causes ifs Corporate Seal to be affixed, end these present~ fo be subserved by a majority of the said Board es of this date. TERMS and C. ONDfflONS Candace M. Corlett n~ arview Southold, v~ .. ~ Road, part of the coosidea'ation for the issuance of ~e P,"~m~t does tmderstand and pvescrlbe to the fol- lowing: 1. That the sald Boaz'd of T~ and the Town ot 8a~thotd a~e released from any amd all damage& oc ~-~,,~ for damageq o~ mia ~sing dim:dy et indimaty as · result of my opet- wltb req~ecx thereto, .to the complete ezdmion of the Board o~' T~.~_ a~ the Tmvn a~ 8o~daold 2. That d,;, permit is valid for ·pedod of ;>4 m~_ wk~4~ b o0ix~qbJeted to be the estimated dme'tequlred to c~nplete the wotlc involved, but daould circumstances wartxm, request for an ~on may be made to ~e ~ at a later ~ 3. That this Permit d~ould be tx.~ined inde~inltely, or as long as the said P~ ~d=sbes to maie~, the structure or project involved, to provide evidence to anyone concerned chat tuth- o~__-tloo was odginaHy obtained. 4. That the work involved will be subject to the in~ and approval of the Board agents, and non-mmp~i,~e with. the provisions tff the ori~n-~.,g appficatlon, may be cause revocation of this l~!~ by r-'~ohdon of the said Boa_,d. 5. Thac them will be tm unteasomble iflterfe~ence with nivig~ti,~ iLS ·rcsult of thc wm:k ~ -'..~ f~thodzed. 6. That there shah be no interfereace with the tight of the puidk eo ~ mad ~ sloag the beach between high and low water m~ks. 8. That the s~id Board will be notified by the Pesmittee ot d~e o0n2j~d~ O~ ~ work such- orlzed. 9. That the Petmittee will obtain all ol~e£ permits and conse~b dutt m~y ~e ~ ~ plemental to this permit which may be subject to revoke upoa f, ll,,,~, to obCdn _-,~ Albert J. Krupski, President James K/ng, 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 May 27, 2003 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Mr. Dan Hall Land Use Ecological Services, Inc. 2576 Sound Avenue Baiting Hollow, NY 11933 SCTM#90-4-8.1 & 8.2 Candace M. Corlett 300 Clearvi~w Road Southold, NY Dear Mr. Hall: The Board of Town Trustees took the following action during a Regular Meeting, held on May 21, 2003 regarding the above matter WHEREAS, Land Use Ecological Services, Inc. on behalf of Candace M. Corlett applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated April 7, 2003 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 May 21, 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 question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 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 Land Use Ecological Services, Inc. on behalf of CANDACE M. CORLETT for a Wetland Permit to construct extensions and additions to an existing single family residence a 603.5 s.f. +/- covered pomh is proposed with a new entry on the front of the existing residence a 745 +/- addition is proposed on the north and east side of the existing residence 768 +/- s.fi of deck area is proposed on the east side of the residence a 2 l 6 +/- s.fi screened pomh is proposed on the south side of the residence a 31'x22' (682 s.fi) detached garage is proposed south of the existing residence. Pervious earth driveway in front of residence and to access proposed detached garage- proposed structure to the wetlands line is the proposed deck, which is proposed to be setback 86 feet. With the stipulation of a hay bale line during construction at fifty foot back from the wetland line - drywells and gutters on the house on all of the extensions. 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. Inspections are required at a fee of $5.00 per inspection. (See attached schedule). FEES: $5.00 Very truly yours, President, Board of Trustees AJK/cjc cc DEC Building Department Albert J. Krupski, President'~' James King, Vice-President Henry Smith Artie Foster Ken Poliwocla Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 7654823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Land Use Ecological Services on behalf of CQNDACE CORLETT Please be advised that your application, dated April 7. 2003 has been reviewed by this Board, at the regular meeting of ~.~.~_y 2!, 2993 and the following action was taken: ( X ) Application Approved (see below) (__.) Application Denied (see below) ( ) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: One Inspection @$5.00 each TOTAL FEES DUE: $ SIGNED: BY: PRESIDENT, BOARD OF TRUSTEES 4/98 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 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. CANDACE CORLETT INSPECTION SCHEDULE __ Pre-construction, hay bale line __ 1st day of construction % constructed __ Project complete, compliance inspection. X DRYWELLS Albert J. Krupski, President James KJ. ng, 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. INSPECTION SCHEDULE Pre-construction, hay bale line st 1 day of construction ¼ constructed ,./Project complete, compliance inspection. Te].ephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 11')9 Southokl. New Yo~k 11971 SOUTHOLD TO~VIq CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, May 13, 2003, the following recommendation was made: Moved by Don Wilder, seconded by Bill Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of CANDAOE M. OORLETT to construct additions to an existing single-family dwelling. A 603.5 sf. covered porch with a new entry on the front of the residence, a 745 sf. addition on the north side and east side of the residence, 768 sf. of deck area on the east side of the residence, a 216 sr. screened porch south of the residence, and a pervious earth driveway in front of the residence and to access the proposed detached garage. Located: 300 Clearview Rd., Southold. SCTM#90-4-8.1&8.2 The CAC recommends Approval with the Condition that hay bales are placed down before construction. Vote of Council: Ayes: All Motion Carried CANDACE CORLE'Fr 84-3.3 KENDRICK PLACE JAMAICA ESTATES, NY ! 1432 May 12, 2003 Board of Trustees Southold Town Southold, NY 11971 To Whom It May Concern: Please give Walter Corlett the copy of the cover page for the submission to the Board of Trustees for the permit application for the house renovation. This should show the date when the application was submitted to the Board. Thank you. .Candace Co/dett LandUse April 4, 2003 Town of Southold Board of Town Trustees P.O. Box 1179 Southold, N.Y. 11971 Re: Corlett - Southold Proposed House Extension / Additions To whom it may concern: Enclosed please find an application package whicl APR - 7 Seuthoid Town Board ot T~'ustees ~.;ud~ the TOIIOWlng: - (1) original, (2) copies of the completed application form. - (1) original, (2) copies of a Short Environmental Assessment Form - (3) sets of Plans. - Application fee ($200.00). If there are any questions, or if you require additional information please don't hesitate to contact this office. DH Enc. Express Mail Sincerely, Land Use Ecological Services, Inc. 25.76 Sound,-.~nu~ .... · Baiting Hollow Ne.',, "&srk · 119'3.3 63 i 7'27 2400 · -" ~ h,~x 6J1 7272605 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only .~oastal Erosion Permit Application ~;etland Permit Application Major Waiver/Amendmen. t/(~hapge.s Received Application: ?~ ~0 ..5 Received Fce:$ Completed Application Incomplete '' '' SEQRA Classification: Type I Type II Unlisted __Coordination :(date CAC Referral Sent: t't'l...I T~ ! ~. ~ Date of Inspection: Receipt of CAC Report: J ' t - Lead Agency Determination:__ Technical Review: ~'. Public Hearing Held: Resolution: Minor APR 7 200 $outhotd Town Board of Trustees Name of Applicant Candace M. Corlett Address 84-35 Kendrick Place Jamaica Estates, NY 11432 Phone Number:( ) 212-924-7780 Suffolk County Tax Map Number: 1000- 90-4- 8.1 & 8.2 Property Location: 300 Clearview Road Southold, NY Northeast corner of Clearview Road and Docjwood Drive (provide LILCO Pole #, distance to cross streets, and location) AGENT: Dan Hall/Land Use Ecological Services, Inc. (If applicable) Address: 2576 Sound Avenue Baiting Hollow, NY 11933 Phone: 631-727-2400 Board of Trustees Applioation GENERAL DATA Land Area (in square feet): ~.8,793.49 s.f. ArQ Zoning: Residential Previous use of property:. Intended use of'property:_ Residential Residential Prior permits/approvals for site improvements: Agency Date N.Y.S.D.E.C~ (dock) Southold Trustees (dock) 3/12/03 11/20/02 __ 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):__ Please see attached oroject description. Corlett- Southold Project Description: Applicam proposes extensions and additions to an existing single family residence. A 603.5 s.f. +/-covered porch is proposed with a new entry on the fi'ont of the existing residence. A 745+/- addition is proposed on the north and east side of the existing residence. 768+/- s.f. of deck area is proposed on the east side of the residence. A 216+/- s.f. screened porch is proposed on the south side of the residence. A 31' x 22' (682s.f.) detached garage is proposed south of the existing residence. A pervious earth driveway is proposed in t?ont of the residence and to access the proposed detached garage. The nearest proposed structure to the wetlands line is the proposed deck which is proposed to be setback 86'. Board of Trustees ApplicatiOn WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: House Expansion / additions. Area of wetlands on lot: 1,450 +/- square feet Percent coverageoflot: 3.6 +/- % Closest distance between nearest existing structure and upland edge of wetlands: 90 +/- feet Closest distance between nearest proposed structure and uplfind edge of wetlands: 86+/- feet Does the project involve excavation or filling? X No Yes I£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): This project will not have any negative affect on the adjacent wetland areas. Board of Trustees Application County of Suffolk State of New York Dan Hall/Land Use Ecological Services, Inc. BErNG DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS TH~ APPLICANT FOR THE ABOVE DESCFJBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF H/S/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, TItEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CON/UNCTION WITH REVIEW OF THIS APPLICATION. SWORN TO BEFORE ME THIS /'" Slgnatur6t ~vt ' ~ 7 /'~ DAYOF CYNTHIA ALVAREZ NOTARY PUBUC, STATE OF NEW YORK No. 01 AL6080878 {IUAUFIE0 IN SUFFOLK C0Urfh' MY COMMISSION EXPIRES SEPT. Name: Joseph Monaco Jr. Robert & Gurly Maus PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 595 Oakwood Ct.,P.O. Box742 Sou~old, N.Y. l1971 450 Clearview Rd. Southold, NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK '~ ~" , residing at ~;c~ D."C, I{q6l , being duly swprn, deposes and Says that o~ the ~w~ day of kY ,~ZooS, deponent mailed a true copy of the NotiCe set 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 sa~d persons as shown on the current assessment roll of the Town of Southold; that s~d Ngtices were mailed at the United States Post Office at ~n~ , that said Notices were ma~led to each of said persons by ,(certified) (registered) mail. -~~ ff~ / ' 6YNTH~A ALVA~E~ I NOTARY PU.LIC, STATE OF N~ ~RK / Nm 01AL6080878 ~-, ~/ ~ I Q~LIFIED IN SUFFOLK COU~ S~O~ Co~e~o~e me Ibis ~/ I ~COMMISSlON~IRESSE~23,2~' ~/ --Not~ Publ~ / / ~bert J. Krupski, James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I,.~--~( ~ t~ , residing at bein~ dul~ sworn, depose and say: Tha~ on hhe ~ day of ~0~ 200~ I pe:sonally posted ~e~ 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 eight days prior to the date of~)~ publ%c heari~ Date ~f he~rigg noted thereon to be held ~ Dated: Sworn to before me this Notar~ Public [ NOTARY PUBLIC, STATE OF NEW YORK J No. 01AL6080878 [ MY QUALIFIEOINSUFFOLKCOUN~ . EM COMMISSION EXPIRES SEP'I:. 23, 20~.~ 72~2805 L:L%'D USE ECOLOGICAL ~k~ard of T~stee~ Apl):L~oati AUTHOR~ATIO~ (where the appltcan= iR not the owner) I, Candace M. Oorlett "'(D~nt owner 6f property) residing at 84-35 Kendriok Place (mailing ad,tess } Jamaica Estates, NY do hereby authorize. (Agent) Land Use Ecological Serviees'_t~%' apply for ~ermit(s} from the Southold Boar~ of Tow~ Trus~ee~ on my beh&lf. /(Ow~e~' s eiemature) / PROJECT ID NUMBER PART 1 - PROJEGT INFORMATION 1. APPLICANT / SPONSOR D Hall/Land Use for Candace M. Corlett 3,PROJECT LOCATION: Soua]old Municipality 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNUSIED ACTIONS Only ( To be comple(ed by ,~ pplioant or Project Sponsor) ' 2. PROJECT NAME Codett - Southold Surf(Ak County 4, PRECISE LOCATION: Street Adders and Road Intersections. Pmmlneet landmarks eL -or I~oV~le m~o 300 Cleanaew Rd. Sot;thoM, NY 1197'1 SCTM# 1000-90-4-8.2 SEQR 5. IS PROPOSED ACTION; [] New [] F-xpan~lan r'~ Modillcatlon I alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially .89+/~ sores Ultlmatef/ .89+1- acres 8. WILL PROPOSEO ACTION COMPLY ~ EXISTING ZONING OR OTHER RESTRICTIONS? []YES [] NO If no, desatbebnie~: g. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) I--lO.er (de~) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FRObl ANY OTHER GOVERNMENTAL AOENGY (Federal, Slate or I.o~al) []Yes ~lNo If yes, list agescy name-,.and penttlt I appmvet: USACOE, NYSDOS, & SOUTHOLD TOWN 11.DOES ANY AEPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL*;' r~lYee ~-"lNo II yes, list agency name ~ pemllt I approval: 1jL. ~esAjaY RESULT~..1No OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE A~plicant. S/~.sor Name Dan H$11 I~/~tdd Use, E/o~g~l Services, Inc. Date: L~ - ~--¢3~ If the actlo~ Is a Costal Area, and you am a state agency, complete the Coastal Assessmont Form before proceeding with this assessment IPROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR D Hall/Land Use for Candace M. Codett 3.PROJECT LOCATION: Southold Municipality 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM fo~ UNLISTED ACTIONS Only ( To be completed by A ~licant or Project Sponsor) 2. PROJECT NAME Codett - Southold Suffolk 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or ix~ovlde map 300 Clearview Rd. Southold, NY 11971 $CTIvI~ 1000-90-4-8.2 5.1s PROPOSED ACTION: [] New [~F. xpanNan [~Modiflnet~an/alteration SEQR 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: In;~#y .89+/- acre~ ~timate!y .89+/- acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? []Yes [] No ff no, de~crl~bdefly: 9. WHAT 18 PRESENT LAND USE IN VICINITY OF PROJECT? (Chanseasrnenyasap~ly.) [:~]Of~er (desce'be) 10. DOES ACTION INVOLVE A PERMIT N=PROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AOENCY (Federal, stere m' Lo~l) []Yes r~No ff yes, list agancy name-and pmmlt I appro~ll: USACOE, NYSDOS, & SOUTHOLD TOWN 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~]Yes F~INo If yes, list agency name and permit I approval: lr~A.S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? rites [] No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Appl~t .J._Sponeor Name Dan H~II/[/)arid Use E,~:)l~)g'!~l Services, Inc. Date: t~ - .~ 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 (1'o be completed by Lead Agency) ^. DOES ACTION EXCEED ANY TYPE ~ THRESHOLD IN 6 NYCRR, PART 617A? If yes, coordiuate the review proc~ a~d use the FULL EAF. B. WlLLACTION "ECEIVECOORDINATEDREVI~N',~'.~I~ROVIDED F(~R'UNM~TEDAC'i'IObiSI~61'~YcR"R, PART'617.67 If~.a regative C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. F_xl~ng ;air quality, surtaca or ~'sunckvater quality or quantity, noise levels, e~dsting traffic paifem, solid waste pro~uctics or disposal, I, C5. [Grov~h, ~3~quent ~va~ or rdiate~ a<~vNe~ ~ely io I~ k~uced'by the 'pml~xl ~lca? F.~n Ixk~ C6. Longterm,~ttem%cun~aitve, cxob~ereffastsn~idm~iedinCt-CS? E~brlefly: , E. IS THERE OR IS THERE LIKELy TO BE CONTROVERSY RE[J~TED TO POI~ITIAL ADVER,~E EN~, RONME,NTAL IMPACTS? If ~ explain: PART Ill - DETERMINATION OF ,~IGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effas~tde~tified above, detem~ine whether it is substantial, large, important or o~erMse significant. Each effec~ should be assessed In eonneofic~ with its (a) setting (La. urban or rural); (b) probability of occuntng; (c) duration; (d) irreverslbility; (e) geographic scope; and (t) magnitude, ff necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail ta show f~at all relevant adverea Impacts have bea~ Iden~fed and ad~taly ~ms~. ff question d of part ii wes checked yes, the detarmination of slgr~canca must evaluata the potential impact of the proposed action on Ihe environmental charactertstics of the CEA. Check this box If you have Ideflffiecl oee or more pofentially large or aignlflcant adv~ I~ ~ ~Y ~r. 'fhen proceed directly to the FUU EAF end/or prepare a pca!tive dedm'aifca. WILL NOT result in any d, gntilca~ adverse envlroemental Impae~ AND provide, o~ attadnments as necassary, the masons supporting thi: Date T~tle of Responsible Officer print or T~tpe Name ~ Respor~ible Officer in Lead Agency Signature of ReSl~onsible Officer in Lead Agency ~ignature of Preparer (If different kom responsible officer) PART II - IMPACT ASSESSMENT (To be oompleted by Lead Agency) A. DO~S ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 ff yes, coordinate the renew process and use the FULL EAF. B. WILL ACTION RECEIVE CO~)RDINATED REVIEW A~ PRC)~D~ FOR'UNLISTED' ACTI(~,I~ IN 8 NYCRR. PART el?.e? if No, a negative r-lw, C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legit~e) Cl. Exl~ng air quality, a~face (x g~oundwatar quality o~ quantity, noise levels, exisling traffic gattem, ~31id waste productioe or ~sposal, E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVE.R_SY RELATED TO POTENTIAL ADVERSE..ENVOI. RONMENTAL IMPACTS? ff yes explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~re~chadvemeeffeeUde~edab~e~detsrm~newhatheririssubatan~a~arge~imp(~1ant~r~theP~v~seatgn~c~nt` Each effec~ should be assessed tn co~necao~ with Its (a) setting (i.e. urban ~ mrat); (b) probability of occurflng; (c) d~; (d) irrevemibaity;, (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference suppor~ng materials. Ensure thai explanalions contain suffietsnt detatl to show f~lat all relevant edveme Impacts have been Idenlif~ed and adequataty addressed. If question d of part II was checked Check thle box if ~u have Identified ene or more potentially larga or sigaificant adveme Impacts which MAY occur. '13~e~ proceed directly to ff~e F UL Cbee~ this bex If you hase detsrmlned, based en Ibe InfamYaion aed enalysis abeve and asy euppo~ng doc, ume~aflon, Ibet the proposed aerie WILL NOT result in any ~ adverse envlrenmer~al Irnpa~ AND ixovlde, on attachrsenls as neoessae/, the reason~ eupp(xting thl: Nmne c~ Lead Aganey Date Print or T~tpe Name of Responsible O~ce~ in L~:I Agency T~e of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer)