HomeMy WebLinkAboutLove Lane Aquisition CorpTOWN
Telephone (516) 765-1800
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
A~II'IJCATION FOR PUBLIC ACCESS TO RECORDS
INSTRUCTIONS: t ease complete Section I of this form and give to Town Clerk's
Office (agency F,~, t,m~ of Information Officer). One copy will be returr~ed to you
in response to yc~r ',,quest, or as an interim response.
SECTION I.
TO: J ~.~ :_.~
(Department or C'ticer, ii!' known, that has the information you are requesting.)
RECORD YOU WIS;ti t'O INSPECT: (Describe the record sought. If possible, supply
date, file title, ta~ ir) number, and any other pertinent information.)
Signature of Applica, .~: ~rv~ ~' ~
Printed Name: I,~ £~ .~..__ ~ ·
Address: I(~,~.j[~ .(~"L~,,.. ~ ~~--
Mailing Address (if cfferent from above): ~-0,
Telephone Number::. ~O~q Date:
................................................................. ~O ........ =--=
[ ] APPROVED
[ ] APPROVED WIT,I DELAY* [ ] DENIED* AU~ ~ ~
~' .~~: Soeth0Jd Tow. Clerk
A. NJ, ille~ Date
Freedom of Infor[~ ,~tion Officer
* If delayed or den~e~ see reverse side for explanation.
Albert J~ Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095Route 25
P.O. Box 1179
Southold, NewYork 11971-0959
Telephone(631) 765-1892
Fax(631) 765-1366
TO:
FROM:
DATE:
RE:
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Elizabeth A. Neville, Town Clerk
Board of Trustees
January 10, 2005
Foil Request of Joan B. Robbins
The file of Love Lane Acquisition Corp., SCTM#117-8-18 is available in the Trustees
office for review between the hours of 8:00 AM - 4:00 PM.
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
Southold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.nor thfork,net
OFFICE OF TI-IE TOWN CLERK
TOWN OF SOUTHOLD
TO:
FROM:
Southold Town Trustees' Office
Linda J. Cooper, Deputy Town Clerk
DATE: January 4, 2005
Foil Request of Joan B, Robbins
Transmitted herewith is a FOIL request of Joan B. Robbins. Please respond to
this office within five (5) business days.
Thank you.
REGISTRAR OF VITAL STATISTICS
MARI~AGE O~'~ICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF II~IFORMATION OFFICER
Town Hall, 5~095 M.t- ~
P.O. Box 1179
Southold, New York 11971
Fax (65D 765-6145
TelephoNe (631) '/65-1800
southoldtown.nor thfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
APPLICATION FOR PUBUC ACCESS TO RECO4~DS
INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's
Office (agency Freedom of Information Officer). One copy will be returned 'to you
In response to your request, or as an Interim response.
SECTION I.
(Department or Officer, if known,' that has th'& information you are req~sting.)' '
RECORD YOU WISH TO INSECT: (Describe the r~ord sought. If possible, Supply
date, file title, tax map numar, and any other pertinent information.)
Pr l l ¢oa_P,e'WT C oed
"signature of Applicant: G~-- ~ . ~
Mailing Address (if different from above): ~.d, ~g
Telephone Number: q~--~0 ~9 Date:
[ ] APPROVED
[ ] APPROVED WITH DELAY* [ ] DENIED*
EIIzabetl~'A. Nevlller
Freedom of InfOrmation Officer
· I I'LltJlfl:
RECEIVED
JAN 2005
Date
S0uthold Town Clerk
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
Town Hall, 53095 Main Road
P.O. Box 1179
$outhold, New York 11971
Fax (631) 765-6145
Telephone (631) 765-1800
southoldtown.northfork.net
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
TO: Southold Toxvn Planning Department
t/gouthold Town Board of Trustees
FROM: Elizabeth A. Neville, Southold Town Clerk
DATE: February 12, 2003
RE: 2/12/2003 FOIL Request of Brian A. Andrews, Esq.
Transmitted herewith is a FOiL request of Brian A. Andrews
Please respond to this office, in writing, within five (5) business days.
Thank you.
BRIAN A. ANDREWS, ESQ.
POST OFFICE BOX 207
235 WICKS ROAD
NEW SUFFOLK, NEW YORK 11956
631-734-2555
February 11, 2003
Southold Town Hall
53095 Route 25
Southold, New York 11971
RECEIVED
FEB 12 2003
Attention: Freedom of Information Officer
Re: Love Lane Acquisitions/Cove View Marina
New Suffolk, New York
$outhold Town Clerk
Dear Sir/Madam:
Please accept this letter as application under the Freedom of Information Act for all
documents pertaining to applications made over the last three years to the Town of Southold
Planning Department and/or Tm.stees pertaining to the waterfront property located in New Suffolk,
New York owned by Love Lane Acquisitions located in New Suffolk, New York.
Allow me to thank you tbr your gracious assistance in this matter.
Very truly yours,
BAA:dp
Trustees
Town of Southold
The New Suffolk Civic Association wants to convey its concerns about the proposed expansion of the
existing marina being proposed by the Love Lane Acquisition Corporation on the New Suffolk waterfront.
As proposed, it will have a profound effect on this hamlet and the surrounding marine communities.
Much of this property has been used commercially for over a century: as a submarine base, for
shipbuilding, as a marina and shipyard, and for many decades as the location of a fuel business (coal, home
heating oil, automotive oil, diesel fuel). The result of this activity has been increased contamination of the
bay bottom, the harmful effects of which will be aggravated by the proposed dredging.
We have been advised by the Peconic Baykeeper of the following points:
a. Dredging this area will re-suspend and disperse heavy metals and other pollutants
throughout the area.
b. Dredging of this magnitude will remove all of the benthic organisms that may be present in
the bottom and become a Iow-oxygenated pollutant sink.
C. The proposed wavE; baffle will have an effect on the along-shore currents in the area and
may have an adverse effect on the stability of adjacent shorelines.
d. Enlarging the existing marina from approximately 30 to 70 slips will impact water quality as
a result of more boats and accidental fuel and oil spi[lages.
We believe that a project of this magnitude clearly requires a positive declaration pursuant to the State
Environmental Quality Review Act. It is therefore essential that the developer be required to prepare and
submit a new Draft EIS/EIR. The future of our hamlet is at stake.
Copies to: Charles T. Hamilton
New York State DEC
Building 40
SUNY
Stony Brook, NY 11790
ALSO: Assemblywoman Patricia Acompora
State Senator Kenneth T. LaValle
Southold Town Board
Southold Town Planning Board
July 29. 2002
To: Southold To~vn Trustees
From:
Stephan Roussan
415 Third St.
New Suffolk, NY 119:56
To the Southold Town Trustees:
Enclosed are signatures on a petition that my family and I circulated during a yard sale
we held a few weeks ago. It addresses the potential environmental impacts relating to the
marina project at the foot of Main Street in New Suffolk. More than 120 people signed
the petition in just a few hours. Please include this petition in your files and discussions
as you evaluate the project. If you have any questions about it, please don't hesitate to
call me at work: 631-298-5471.
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DEIS/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name Address Date
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DEIS/EIR) of the Cove View Marina Project pursuant to SEQRA.
Address Date/,
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DEIS/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name
?~ ,'
Address
Date
7 -~ -
'q.
7 - 06 -02'
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DEIS/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name
Address Date
5.6.0%
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DE1S/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name _ , Address Date
h
P/d,"
f
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DEIS/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name
Address Date
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southoid Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DE1S/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name Address Date
I~ ~O-~oy~o~ ( '
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact 'Statement and Environmental Impact Review
(DEIS/EIR) of the Cove View Marina Project pursuant to SEQRA.
Name
Address
Date
PETITION TO ENSURE PROTECTION OF THE NEW SUFFOLK
WATERFRONT
We, the undersigned residents of Southold Town, are concerned about the
effects of the proposed expansion of the existing marina on the New
Suffolk waterfront. We ask that the Southold Town Trustees require a Draft
Environmental Impact Statement and Environmental Impact Review
(DEIS/E1R) of the Cove View Marina Project pursuant to SEQRA.
Name
Address
DaLe
'/
July 9, 2002
Southold Town Board of Trustees
Southold Town Hall
PQ Box 1179- 53095 Main Road
Southold, NY 11971
Re: Cove View Marina - SCTM# 117-8-18
The New Suffolk Civic Association wants to convey its concerns about the proposed expansion of the
existing marina being proposed by the Love Lane Acquisition Corporation on the New Suffolk waterfront.
As proposed, it will have a profound effect on this hamlet and the surrounding marine communities.
Much of this property has been used commercially for over a century:
· As a submarine base, for shipbuilding,
· As a marina and shipyard,
· And for many decades as the location of a fuel business (coal, home heating oil, automotive oil,
diesel fuel).
The result of this activity has been increased contamination of the bay bottom, the harmful effects of which
will be aggravated by the proposed dredging.
We have been advised by the Peconic Bay keeper on the following points:
1. Dredging this area will re-suspend and disperse heavy metals and other pollutants throughout the
area.
2. Dredging of this magnitude will remove all of the benthic organisms that may be present in the
bottom and become a Iow-oxygenated pollutant sink.
3. The proposed wave baffle will have an effect on the along-shore currents in the area and may have
an adverse effect on the stability of adjacent shorelines.
4. Enlarging the existing marina '[rom approximately 30 to 70 slips will impact water quality as a
result of more boats and accidental fuel and oil spillages.
We believe that a project of this magnitude clearly requires a positive declaration pursuant to the State
Environmental Quality Review Act. It is, therefore, essential that the developer be required to prepare and
submit a new Draft EIS/EIR.
The future of our hamlet is at stake.
Sincerely,
Lauren Grant, Pres dent
New Suffolk Civic Association
Cc:
Charles T. Hamilton-NY State DEC
Senator Kenneth T. La Valle
NY State ,~Ssemblywoman Patricia Acampora
Southold Town Supervisor Josh Horton and the Southold Town Board
Southold Town Planning Board Chairman Bennett Orlowski and the Town Planning Board
NEW SUFFOLK CIVIC ASSOCIATION, IN(-;. POST OFFICE BOX 642 NEW SUFFOI.K, NY 11956
ELIZABETH A. NEVILLE
TOWN CLERK
REGISTRAR OF VITAL STATISTICS
MARRIAGE OFFICER
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER
%~fFOL/c %,
Town Hall, 53095 Main Road
P.O. Box 1179
Southo!d, New York 11971
Fax (516) 765-1823
Telephone (516) 765-1800
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 Freeddm of Information Officer). One copy will be returned to you
in response to your request, or as an interim response.
SECTION I.
TO:
(Department or Officer, if known,
that has the information you are requesting.)
RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible,
date, file title, tax map number, and any other pertinent information.)
supply
Signature of Applicant: ~ ~
Printed Name: ~-~/ ~-'//~.
Address:
~iling Address (if different from ~bove}:
Telephone Number: ?~lf~fl ~ Date:
[ ] APPROVED RECEIVED
[ ] APPROVED WITH DELAY* [ ] DENIED*
Freedom of Information Officer
OCT 3 1 ~'~
Date ,
Southold Town Clerk
* If delayed or denied see reverse side for explanation.
~IO~hn~I ~rlDOHDJ~rlD
r"r, T t'~r I !gl I
New York State Department of Environmental Conservation
Division of Environmental Permits, Region One
Building 40 - SUNY, Stony Brook, New York 11790-2356
Phone: (631)444-0365 · FAX: (631)444-0360
Website: www.dec.state,ny,us
Edn M. Crotty
Commissioner
May30,2002
Albert Krupski, Jr.
Board of Town Trustees, Town of Southold
Town Hall
53095 Route 25
P.O. Box 1179
Southold, NY 11971-0959
Dear Mr. Krupski:
I am writing in response to your lead agency coordination request for the Cove View Marina
project on Main Street in New Suffolk. The NYSDEC has no objection to your agency asstmaing
the responsibilities of lead agency for this project. Issues of concern which we feel should be
evaluated include the impacts of this project on shellfish and finfish habitats and the potential re-
suspension of contaminants within the marina basin.
Thank you for requesting comments at this early stage of the project. As the project develops and
more details become available, we would appreciate the opportunity to comment further.
Sincerely,
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
May 13, 2002
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
Re: Lead Agency Coordination Request
Dear Reviewer:
The purpose of this request is to determine under Article 8 (State Environmental
Quality Review Act-SEQRA) of the Environmental Conservation Law and 6
NYCRR Part 617 the following:
1. Your jurisdiction in the action described below;
2. Your interest in assuming the responsibilities of lead agency; and
3. Issues of concern that you believe should be evaluated.
Enclosed please find a copy of the proposal and a completed Environmental
Assessment Form (EAF) te assist you in your response.
Project Name: ~_~Q. L~,¢,_O ~'~-~.C~
Requested Action: ~;~2~¢~, 0._~[~.~,~ ~)Etn'~,<,Ltto~ ~[-~'~L~ttC[
SEQRA Classification: ( ) Type I
Contact Person:
(631) 765-1892
Page 2
Lead Agency Coordination Request
The lead agency will determine the need for an environmental impact statement
(ELS) on this project. Within thirty (30) days of the date of this letter, please
respond in writing whether or not you have an interest in being lead agency. If no
response is received from you, it will be assumed that there is no objection to the
Board of Trustees assuming lead agency status.
Comments:
Please feel free to contact this office for further information.
Very truly yours,
Albert Krupski, Jr.
President
CC:
Army Corp. of Engineers
Dept. of State
DEC
(*Maps are enclosed for your review)
· 14-16-2
617.20
Appendix A
Stale 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 signit~icant is not always easy to answer. Frequent-
ly, 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 addition, many who have knowleclge in one particular area may not be aware of the broader concerns affecting
the question of significance.
The full E^F is intended to provide a method whereby applicants and agencies can be assured that the determination
process has been orderly, comprehensive in nlature, yet flexible enough to allow introduction of information to fit a project
or a~:tion.
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 assists a reviewer in the analysis that takes place in Parts 2 and 3.
Part 2: Focuses on identifying the range of possible impac~ that may occur from ~ project or action. It provides
guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially-
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 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 EAF compJeted for this project: I-I Part 1 i-1 Part 2 [}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 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 on the environment, there will not be a significant
effect for this Unlisted Action because t~e mlflgatlon measures described in PART 3 have been required,
therefore a CONDITIONED negative dedasation will be prepared.*
C. The project may result In one or more large and important Impacts that may have a s!gnificant 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
Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer (if different from responsible officer)
Date
1
PART 1--PROJECT INFORMATION
Prepared by Project Sponsor
NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effect
on the enviro'tment. 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 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.
NAME OF AG"rION
LOCATION OF A~ION 0~lude Street Address. MunlclpalUy and
NAME OF APPUCANT~PON~R
ADORE~
NAME OF ~NER Of
ADDRESE;
BUSINESS TELEPHONE
I
STATE I ZIP CODE
BUSINESS( ) TELEPHONE
CATY/PO J STATE { ZIPCOOE
DESCRIPTION OF ACTION
Please Complete Each Question--indicate N.A. If not applicable
A. Site Description
Physical setting of overall project, both* developed 1nd undeveloped areas.
1, Present land use: I-IOrban rllndustria[ j~i,Commerclal C]Residentiai (suburban) ~Rural (non-farm)
DForest rlAgticulture r'lOther
2. Total acreage of project area: %~' ~[) ~/~ ~ .~acres.
APPROXIMATE ACREAGE - PRESENTLY AFTER COMPLETION
Meadow or Brushland (Non-agricultural) acres acres
Forested acres acres
Agricultural (includes orchards, cropland, pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres
Water Surface Area acres acres
Unvegetated (Rock, earth or fill) acres acres
Roads, buildings and other paved surfaces acres acres
Other (Indicate type) ~fl-7 Yr:(k'l'~ ~ ~/ ' ~
L acres · · . acres
3. What is predominant soil type(s) on project siteJ ~-'~ ¢')~ ~ ~ ;'£~-~ ~
a. Soil drainage: I~Well drained I (, .~ % of site C]Moderately well drained % of site
npoorly drained % of site
b. If any agricultural land is Involved, how many acres of soil are classified within soil group I through 4 of the NYS
Land Classification System:/ acres. (See '1 NYCRR 370).
4. Are there bedrock outcropplAgs on project sltel C]Yes I~lNo
a. What is depth to bedrock1 (in feet)
5. Approximate percentage of proposed project site with slopes: I~0-10% / ,7 o % {310-15% _ %
Q1S% or greater %
6. Is project substantially contiguous to. or contain a building, site, or district, listed on the State or the National
Registers of Historic Places? E}Yes ~]No
7. Is project substantially Contiguous to a site listed on the Register of National Natural Landmarks? QYes ~.No
8. What is the depth of the water table? ~ :(- (in feet)
9. Is site located over a prirriary, principal, or sole source aquifer? I-lYes ,~DNo
10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? I~Yes QNo
11. Does project site contain any species of plant or animal life that is identified as th~'eatened or endangered?
QYes ~o According to
Identify each species
12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations)
Q-lYes ~3~1o Describe
13. Is the project site presently used by the community or neighborhood as an open space' or recreation area?
l-lyes '~No . If yes, explain
14. Does the present site include scenic views known to be important to the community? l-lYes ~No
15. Streams within or contiguous to projec~ area: -f~d~ c c ~ ~ ~- ~ ~ ~/ a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland areas within or contiguous to project area:
a. Name b. Size (In acres)
~.7. ;s ~.he site served by existing public utilitlies? I~Yes F'JNo
a) If Yes, does sufficient capacity exist to allow .donnection? ~[lYes E]No
b) If Yes, will improvements be necessary to allow connection? C]Yes
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA,
Section 303 and !~)47 r-lyes ~No
19. If the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8
of the ECL, and 6 NYCRR 617i' nYes I~No '
20. Has the site ever been used for the disposal of solid or hazardous wastes? I-lyes ~No
B. Project Description
1. Physical dimensions and scale of project If in dimensions as appropriate)
a. Total contiguous acreage owned or controlled by project sponsor ~> I~
b. Project acreage to be developed: _~-I~ acres initially; L~ ~r._
c. Project acreage to remain undeveloped a~ acres.
d. Length of project, in miles: (if appropriate)
e. 'If the project is an expansion, indicate percent of expansion proposed ~ ,~ %;
f. Number of off-street parking spaces existing ; proposed J~'~- t~:
g. Maximum vehicular trips generated per hour ~ ~'- · (upon' completion of p¢oject)['
h. If residential: Number and type of housing units:
One Family Two Family Multiple Family
Ultimately
I. Dimensions (in feet) of largest proposed structure ~ height; ,~,~9 width;
j. Linear feet of frontage along a public thoroughfare project will occupy is? ~ ~-(/
3
acres.
acres ultimately.
Condominium
/ ~0 length.
fL
2, How much natural material (i.e., rock, earth, etc,) will be removed from the site?
3. Will disturbed areas be reclaimed? l~Yes [~No ONIA
a. If yes~ for what intended purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? ~Yes
c. Will upper subsoil be stockpiled for reclamation? E/Yes '~Ho
tons/cubic yards
4. I-Io',9 many acres of vegetation (trees, shrubs, ground covers) will be removed'from site? c_b acres,
5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
months, (including demolition).
month year, (including demolition).
month year. ,
I~Yes f-INo
; after project is complete
[]]Yes ~No If yes, explain
i'"lYes
6, If single phase project: Anticipated period of construction
7, If multi-phased:
a. Total number of phases anticipated (number).
b. Anticipated date of commencement phase 1
c. Approximate completion date of final phase
d. Is phase I functionally dependent on subsequent phases.~
8, Will blasting occur during construction? [DYes I~o
9. Number of jobs generated: during construction /~-
10. Number of jobs eliminated by this project
11. Will project require relocation of any projects or facilities?
12. Is surface liquid waste disposal involved? C/Yes
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 ~No Type ~Db~
14. Will surface area of an existing water body increase or decrease by proposal? ~,Yes' ~No
'IS. Is project or any portion of project located in a 'lO0 year flood plain? ~,Yes
'I6. Will the project generate solid waste? ' [~[LYes [DNo
a. If yes, what is the amount per month \) '2~ tons
b. If yes, will an existing solid waste facility be used? ~Yes
c. If yes, give name ~ °g ~a~43-Ha~t') ;location
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? C]Yes ~l,No
e. If Yes, explain
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~ years.
18. Will project use herbicides or pesticides? [DYes
[DNo
tons/month.
19. Will project routinely produce odors (more than one hour per day)? [DYes ~No
20. Will project produce operating noise exceeding the local ambient noise levels? Q-lyes
21. Will project result in an increase in energy use? '1~Yes E/No
If yes , indicate type{s) /__~-~-~ ~-T-//~ ~_ I-T- 'V
22. If water supply Is from wells, indicate pumping capacity gaUons/minute. '
23. Total anticipated water usage per day gallons/day.
24. Does project involve Local, State or Federal funding? [DYes
If Yes, explain
25. Approvals Required:
City. Town. Village Board ~.Yes [:)No
City, Town, Village Planning Board '~Yes [3No
City, Town Zoning Board [3Yes [:]No
City, County Health Department [DYes [:]No
Other Local Agencies [3Yes [3No
Other Regional Agencies' [::]Yes [3No
State Agencies ~Yes [:]No
Federal Agencies ~[]Yes [3No
Type
Submiltal
Date
C. Zoning and Planning Information
1. Does proposed action involve a planning or zoning decision? ~Yes [3No
' If Yes, indicate decision required:
nzoning amendment []]zoning variance []]special use permit Clsubdivision l~site plan
Phew/revision of master plan [3resource management plan [3other
2. What is the zoning classification(s)of the site[' Tv~ ~
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 siite? ¥~ ~q~
5. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
G. Is the proposed action consistent with the recommended uses in adopted local land use plans? ~.Yes nNo
7. What are the predominant land use(s) and zoning classifications within a ~ mile radius of proposed action?
8. Is the proposed action compatible with adjoining/surrounding land uses within a 14 mile~' (~.Yes [-INo
9. If the proposed action is the subdivisiion of land; how many lots are proposed?
a. What is the minimum lot size proposed?
10. Will proposed action require any authorization(s) for the formation of sewer or water districts? f-lYes ~,No
11. Will the proposed action create a demand for any community provided services (recreation, education, police,
fire protection)? OYes 1~o
a. If yes, is existing capacity sufficient to handle projected demand? ayes C3No
12. Will the proposed action result in the generation of traffic significantly above present levels? f-lYes' ~klo
a. If yes, is the existing road network adequate to handle the additional traffic? [3Yes [3No
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 mitigate or
avoid them.
E. Verification
I certify that the information provided above is true to the best of my knowledge.
Ap lican nsor Name L~ LF~. ~C~LLl6tl ~t~J ~ Date
the action Is in the ~oastal Area, ~nd yorJ are a state agent, complete the Coastal Assessment Form before proceeding
with this ~ment. 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
reasonable'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 threshold 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 constitute an exhaustive list of impacLs and thresholds to answer each question.
· The number of examples per question does not indicate the importance of each question.
· In identifying impacts, cgnsider long term, short term and cumlative effects.
.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 I or 2) to Indicate the potential size of the
Impact. If Impact threshold equals or exceeds any example provided, check column 2. If Impact will occur but
threshold Is lower than example, check column 1.
d. Iden(Ifylng 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 be 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.o the project site~'
C]NO [~YES
Examples that would apply to column 2
· Any construction on slopes of 15% or greater, (15 foot rise per 100 [] I-] [~]Yes []No
foot of length), or where the general slopes in the project area exceed
10%.
· Construction on land where the depth to the water table is less than [~ n []Yes
3 feet.
· Construction of paved parking area for 1,000 or more vehicles. [] I~ [~Yes []No
· Construction on land where bedrock is exposed or generally'within [] [~] [~]Yes [~)No
3 feet of existing ground surface.
· Construction that will continue for more than I year or involve more [] ~] OYes
than one phase or stage.
* Excavation for mining purposes that would remove more than 1,000 [] [~3 []Yes I~]No
tons of natural material (i.e., rock or soil) per year.
· Construction or expansion of a sanitary landfill. [] [] [~]Yes []No
· Construction in a designated floodway. [] [] I~]Yes []No
* Other impacts [] ~] [~Yes []No
1 2 3
Small to Potential .Can Impact Be
Moderete Large Mitigated By
Impact Impact Project Change
2. Will there be an effect to any unique or unusual land forms found on
the sltet' (i.e., cliffs, dunes, geological formations, etc.)C)NO QYES
· Specific land forms:.
[] n OYes ONO
IMPAOT ON WA'rER
3. Will proposed action affect any water body designated as protected?
(Under Articles 15.24.25 of the Environmental Conservation Law, ECL)
ONO OYES
Examples that would apply to column 2
· Developable area of site contains a protected water body.
· Dredging 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:
1
Small to
Moderate
Impact
O
O
O
[]
O
2
Potential
Large
Impact
O
O
O
[]
O
3
Can Impact Be
Mitigated By
Pro,iec! Change
[]Yes ONo
OYes ONo
OYes ONo
OYes ONo
OYes ONo
4. Will proposed action affect any non-prutected existing or new body
of water? ONO OYES
Example{ 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 o! water that exceeds 10 acres of surface area.
· Other impacts:
O
[]Yes ONo
OYes l-INo
OYes ONo
5. Will Proposed Action affect surface or groundwater
quality or quantity? [:3NO OYES
Examples that would apply to column 2
· Proposed Action will require a discharge permit.
· Proposed Action requires use of a source of water that does not
have approval to serve proposed (projecl;) 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.
· Liquid effluent will be conveyed off the slt e to facilities which present!y
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 ti{ere will be an obvious visual
contrast to natural conditions.
· Proposed Action will require the storage of petroleum or chemical
products 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 Impact:
O
O
O
O
O
O
O
D
O
O
O
[3
O
O
O
O
[]
O
O
O
[]
O
OYes ONo
OYes ONo
OYes ONo
OYes ONo
OYes ONo
OYes ONo
[]Yes {]]NO
{]]Yes ONo
OYes ONo
OYes ONo
OYes ONo
OYes ONo
6. Will proposed action alter drainage flow or patterns, or surface
water runoff~ ONO I-WES
Examples that would apply to column ;!
· Proposed Action would change flood water flows.
7
[]Yes [:]No
· Proposed Action may cause substantial erosion.
· Proposed Action is incompatible with existing drainage patterns.
· Proposed Action will allow development in a designated floodway.
· Other impacts:
1 2
Small to Potential
Moderate Large
Impact Impact
Can Impact Be
Mitigated By
Project Change
[=]Yes [:]No
[=]Yes [:]No
[]Yes ON•
[~Yes []No
IMPACT ON AIR
7. Will proposed action affect air quality? mN• I-lYES
Examples 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 I ton of
refuse per hour,
· Emission rate of total contaminants will exceed $ lbs. per hour or a
heat source producing more than 10 million BTU's per hour.
· Proposed action will allow an increase in the amount of land committed
to industrial use.
· Proposed action will allow an increase in the density of industrial
development within existing industrial areas.
· Other impacts:
IMPACT ON PLANTS AND ANIMALS
8. Will Proposed Action affect any threatened or endangered
species[' OHO 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 ot found on the site.
· Removal of any portion of a critical or significant wildlife habitaL
· Application of pesticide or herbicide more than twice a year, other
than for agricultural purposes.
· Ofher impacts-
[] [] ayes ON•
0 [] []Yes ON•
0 [] OYes ON•
[]] 0 []Yes ONo
9. Will Proposed Action substantially affect non-threatened or
non-endangered species[' I:INO OYES
Examples that would apply to column 2
· Proposed Action would substantially interfere with any resident or
migratory 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
10. Will the Proposed Action affect agricultural land resources~
ONO OYES
Examples that would apply to column 2
· The proposed action would sever, cross or limit access to agricultural
land (includes cropland, hayfields, pasture~ vineyard, orchard, etc.)
8
[] 0 []Yes ON•
[] O OYes ON•
~] [] OYes []]No
· 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 create a need for such measures [e.g. cause a farm
field to drain poorly due to increased runoff)
· Other impacts:
1
Small to
Moderate
Impact
2
Potential
Large
Impact
O
3
Can Impact E
Mitigated B)
Project Chan.(
[]Yes [~]N.
[]Yes []N,
[]Yes [~]N,
OYes ON,
IMPACT ON AESTHETIC RESOURCES
11. Will proposed action affect aesthetic resources~' [3NO OYES
(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
enjoyment of the aesthetic qualities of that resource.
· Project components that will result in the elimination or significant
screening of scenic views known to be important to the area.
· Other impacts:
[]
O
[]
[]
O
0
[]
[]
[]Yes ON(
[]Yes ON<
[]]Yes
[]Yes []N(
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
12. Will Proposed Action Impact any site or structure of historic, pre-
historic or paleontological importancel mN• I-lYES
Examples that would apply to co~[umn 2
· Prop•ged 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:
O
0
[]
[]
[]
[]
[]
OYes •Nc
[]Yes ON<
[]Yes ON(
[]]Yes []]Nc
IMPACT ON OPEN SPACE AND RECREATION
13. Will Proposed Action affect the quantity or quality of existing or
future open spaces or recreational opportunitlesl
Examples that would apply to column 2 [:)NO [3YES
· The permanent foreclosure of a future recreational opportunity.
· A major reduction of an open space important to the community,
· Other ImpactS:
0
O
[]
[]
[]
[]
OYes []N,
OYes ON,
[]]Yes []N,
9
IMPACT ON CRITICAL ENVIRONMENTAL AREAS
14 Will Proposed Action impact the exceptional or unique character-
istics of a critical environmental area (CEA) established pursuant to
subdivision 6 NYCRR 617.14(g) ? ~)NO OYeS
List the environmental characteristics that caused the desi§nation o[
the CEA.
1
Small to
Moderate
Impact
2
Poten'tial
Large
Impact
Can impact Be
Mitigated By
Project Change
Examples that would apply to column 2
· Proposed Action to locate within the CEA?
· Proposed Action will result in a reduction in the quantity of the resource?
· Proposed Action will result in a reduction in the quality of the resource?
· Proposed Action will impact the use. function or enjoyment of the
resource?
· Other impacts:
O
O
[]
[]
O
O
[]
[]
O
O
OYes ONo
OYes ONo
OYes E]No
OYes ONo
[]Yes ONo
IMPACT ON TRANSPORTATION
15. Will there be an effect to existing transportation systems?
· [:]NO OYES
Examples that would apply to column 2
· Alteration of present patterns of mo~;ement of people and/or goods.
· Proposed Action will result in major traffic problems
· Other impacts:
O
O
[]
OYes ONo
OYes ONo
[]Yes []No
IMPACT ON ENERGY
Will proposed action affect the community's sources of fuel or
energy supply? ONO OYES
Examples that would apply to column 2
· Proposed Action will cause a greater than 5% increase in th~ use ol
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 serve a maior commercial or industrial use.
· Other impacts:
[]
O
O
[]
[~Yes C~No
[:]Yes ONo
OYes ONo
10
1 2
NOISE AND ODOR IMPACTS Small to Potential
1-7. Will there be objectionable odors, noise, or vibration as a result Moderate Large
of the Proposed Action? [~NO EYES Impact Impact
Examples that would apply to column 2
· Blasting within 1.500 feet of a hospital, school or other sensitive [] [] []Yes []No
facility.
· Odors will occur routinely (more than one hour per day). [] [] []Yes []No
· Proposed Action will produce operating noise exceeding the local O [] []Yes []No
ambient noise levels for noise outside of structures.
· Proposed Action will remove natural barriers that would act as a [] O []Yes I-'IN•
noise screen.
· Other impacts: [] O OYes []No
3
Can Impact Be
Mitigated By
Project Change
IMPACT ON PUBLIC HEALTH
18. Will Proposed Action affect public health and safety? .
DNO DYES
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, irritatinB,
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 fe~t of a site used for the disposal of solid or. hazardous
waste.
· Other impact~:
[] O FiYes []No
O [] OYes I']No
O [] OYes •No
[] FI OYes i-IN0
O O FiYes FIN•
IMPACT ON GROWTH AND CHARAQTER
OF COMMUNITY OR NEIGHBORHOOD
19. Will proposed action affect the character of the existing community?
FIND I-lYES
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 O
will increase by more than 5% per year as a result of this projecL
· 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 .O
or areas of historic importance to the community.
· Development will create a demand for additional community services []
(e.g. schools, police and tire, utc.)
· Proposed Action will set an important precedent for future'projects. O
· Proposed Action will create or eliminate employment. []
· Other Impacts-
FI []Yes I-IN•
n []Yes C]No
[] OYes ON•
O FiYes •No
[] []Yes ON•
O []Yes ON•
[] nYes ON•
O nYes ON•
O []Yes ON•
20. Is there, or is there likely to be, public controversy related to potential adverse environmental imp·cts,'
•NO DYES
I! uny ·orlon In part 2 I~ Identllled al · potential large Impact or If you cannot determine the magnitude o( Impact, proceed lo Part 3
11
Part 3--EVALUATION OF THE IMPORTANCE Oh IMPACTS
Responsibility of Lead Agency
Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even i! the impact(s) may be
mitigated.
Inslructions
Discuss the following for each impact identified in Column 2 of Part 2:
1. Briefly describe the impact.
2. Describe~ifapp~icabie)h~wtheimpactc~u~dbemitigated~rreducedt~asma~~t~m~derateimpactbYpr~jectchange(s)`
3.' Based on the information available, decide if 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 i~;reversibility, including permanently lost resources of value
· Whether.the impact can or will be controlled
· The regional consecluence of the impact
· Its potential divergence from local needs and goals
· 'Whether known objections to 'the proje~:t relate to this impact.
(Continue on attachments)
12
617.20 SEQR
Appendix B
State, Environmental Quality Review
Visual EAF Addendum
This form .may be used to, provide additional information relating to Question ! ] of Part 2 of
the Full EAF,
(To be completed by Lead Agency)
Distance Between
Visibility
1. Would the project be visible from:
· A parcel of land which is dedicated to and available
to the public for the use, enjoyment and appreciation
of natural or man-made scenic qualities?
· An overlook or parcel of land dedicated to public
observation, enjoyment and appreciation of natural
or man-made scenic qualifies?
"A site or structure listed on the Hational or State
Registers of Historic Places?
· State Parks?
· The State Forest Preserve?
· Hational Wildlife Refuges and state game refuges?
· Hational Hatural Landn~arks and other outstanding
natural features?
· Hational Park Service lands7
· Rivers designated as Hatlonal or State Wild, Scenic
or Recreational?
· Any transportation corridor of high expos, ure, 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 deslgnaUon?
· A site, area, lake, reservoir or highway designated as
scenic?
· Municipal park, or designated open space?
· County road?
* State?
o Local road?
Project and Resource (in t4iles)
O-V,~ ~A-1/2 V2.3 3-5 5+
[] [] [] [] []
[] [] [] [] 0
[] [] [] 0 []
[] [] [] [] 0
[] [] [] O' []
[] [] [] [] []
[] [] [] [] 0
[] [] [] [] []
[] [] [] 0 0
[] [] [] [] []
[] [] [] [] O
[] [] [] O []
[] [] [] 0 []
[] O [] [] []
O 0 [] [] []
[] [] [] [] []
Is the visibility of the project seasonal? (i.e., screened b~/summer foliage, but visible during other
seasons)
[]Yes []Ho
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 OHo
DESCRIPTION OF EXISTING VISUAL ENVIRONMENT
4. From each item checked in question 1, check those which generally describe the
environment.
surrounding
Within
*% mile * ! mile
Essentially undeveloped [] []
Forested [] []
Agricultural [] []
Suburban residential [] []
Industrial [] []
Commercial [] []
Urban [] []
River, Lake, Pond [] []
· Cliffs, Overlooks [] []
Designated Open Spa~:e ~] []
Flat [] []
t4ountalnous [] []
Other [] []
HOTE: add attachments as needed
5. Are there visually similar projects within:
*V~ mile i-lYes r-]No
*1 miles F-lYes [-[No
*2 miles i-lYes []No
*3 miles []Yes [-]No
* Distance from project site are provided for assistance. Substitute other distances as appropriate.
EXPOSURE
6. The annual number of viewers likely to observe the proposed project is
HOTE: 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
· FREQUENCY
Holidays/
Activity Dally Weekly Weekends Seasonally
Travel to and from work [] [] [] []
Involved In recreational activities [] [] [] []
Routine travel by residents [~] [] [] []
At a residence [] [] [] []
At workslte [] [] [] []
Other [] [] [~ []
2
617.20
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (1'o be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR j 2. PROJECT NAME
3. PROJECT LOCA¥1ON:
Municipality Courtly
4. PRECISE LOCATION (Street add,ess and road IntersecUon~, prominent landmarks, etc.. ~r provide map)
SEQR
~. ~S PROPOSED ACTION:
6. DESCRIBE PROJECT BRIEFLY:
[] M odlflo~I Ion/alterat Ion
7. AMOUNT OF LAND AFFECTED:.
Initially sues Ultimately
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LANO USE RESTRICTIONS?
[] Y. [] No I! No, describe briefly
WHAT IS PRE~ENT LAND USE IN VICINITY OF PROJECT'/
[] parkZFo~esuOpen apace [] Other
10. ~OF.S AGTION INVOLVE A pERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL.
STATE OR LOC. ALT/
[] Ye~ [] No If l~t, II~t &~a) a~d p~'Itlt/epf~w~l~
11. DOES ANY ASPECT OF THE AG'I'ION HAVE A OURREHTLY VAUD PERMIT OR APPROVAL?
[] Ye~ [] No I! yet, IL~t agency name ~ld.l~mgt/apIx~Y&l
12. AS A RESULT OF PROPOSE0 AG'I1ON WILL EXISTING PERMIT/APPROVAL REOUIRE MOOiFICATIONI'
[] Yes [] No
I CERTIFY THaT THE INFORMATION PROVlOED ABOVE 18 TRUE TO THE BEST OF MY KNO~E
I
If the action Is in the Coastal Ares, and you are a state agency, complete the ~
Coastal Assessment Fon~ belore proceeding with this assessment
I
OVER
1
PART II--ENVIRONMENTAL ASSESSMEt~ /o be completed by Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PART 617.47 If yes. coordinale Ihe rev ew p~oce~$ and use the FULL
f-lYes ONo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLIS'i'ED ACTIONS IN 6 NYCRR. PART 61 ? 6~ II No. a nag&bye decla~ahon
may be superseded by another involved agency.
[] Yes [] No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwriUen, il legible)
Cl. Exiseng air quality, SUftace Or groundwater quality or quanlily, noise levels, exisling Irallic paUerns, solid wasle ploduction or disposal,
potential for erosion, dcatnage or flooding problems? Explain briefly:
C5. Growth, subsequent development, o¢ related activities likely to be induced by the proposed action? Explain briefly.
C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 Explain brieUy.
C7. Other impacts (Includi~'~ changes In use of ellhe~ quantity or type of en~'gy)? Exglalo b~iefly.
O. WILL THE PRO. JEOT HAVE AN IMPACT OH THE ENVIRONMENTAL CHARACTERISTIC~ THAT CAUSED THE ESTABLISHMEN! OF ^ CrA?
0 Yes 0 .o
E. IS THER~ OR IS THERE UKELY TO EE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explain briefly
PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whelher it is substantial, large, Impmlant or otherwise significant.
Each etfect ~hould be assessed In connection with Its (a) astting (i.e. urban o~ rural}; (13) proba~tity o! occuffing; (o) duration; (d}
IrreversllNIIty; (e) geographic sco~e; and (~) magnitude. If ne~ecsary, add attaohmen[s o~ reference supp~ting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse Impacts have been Idonlllled and adequately addressed. If
question D of Part II was checked yes, the determination and alg~ficanoe must eYaluste the po{entlal Impact of the p~oposed action
o~ the environmental characteristics of the CEA.
n Check this box If you have Identified one or more potentially large or significant adverse Impacts which MAY
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration.
[] Check thie box II you have determined, based on Ihe 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:
Date
2
SEQRA RESOLUTION RE: LOVE LANE ACQUISITION SCTM#117-8-18
Resolved by the Board of Trustees of the Town of Southold that the application
of Love Lane Acquisition Corp., more full described in the public hearing section
#16 of the Trustee agenda dated Wednesday, March 20, 2002 is, pursuant to the
SEQRA rules and regulations, is declared an Unlisted Action; and be it
Further resolved that the applicant is required to submit a 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.
PELL. F'TREAU /~ PELLETREAU
A~'TC)RNEYS AND COUN.SELLORS AT LAW
~O CHURCH STREET - BOX IIO
;='ATC. HOGUE:. N~'W YORK
July 24, 1986
Joseph Fenton, Esq.
Jackson St~reet
New Suffolk. New Yo=k 11956
~e: ~arina Say Club, Lcd.
Dear ~. Fenton:
Encl. osed please £ind an executed copy signed
Car~ of the Covenants and Restrictions for
of New Suffolk. New York.
Very truly yours,
PELLETREAU & PELLETREAU
Janet F. Haeberle
Legal Asei~l~tant
JFH:lyn
Enclosures
by Mr. Riohard T.
the Marina Bay Club
Olu(7}
P. O. Drawer A
Jamesport, NY
May 15, 1986
11947
Mr. JoSeph Fenton
Jackson Street
New Suffolk, NY 11956
Dear Mr. Fenton:
Please find enclosed a copy of a letter from
Pelletreau & Pe!letreau to the Southold ~own ~lannln~
Board statinq that Mr. Carr will place a covenant on
the New Suffolk property which will ban full time
residency on boats docked in the slips.
HER:ml
Eno.
CC: Richard Cart
John J. Hart,
Esq.
Sincerely,
~~a~Jr'~'
Telephone
(631) 765-1892
Town H',dl. 53095 Main Road
P.O. Box 1179
Southold, New Yo~k 11971
$OUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Wednesday,
January 16, 2002, the following recommendation was made:
Moved by Scott Hilary, seconded by Bob Ghosio, to
TABLE the Wetland Permit Application of LOVE LANE ACQUISITION CORP. to
remove the existing peninsula and rebuilt bulkheads and travel lift.
Located: 650 First Street, New Suffolk. SCTM#117-8-18
The CAC Tables the application because more information is needed. The CAC
questions if an Environmental Impact Statement is necessary.
Vote of Council: Ayes: All
Motion Carried
That as
"IUIRRI'NR BRY CLUB" by t:he Touan oF Sour.hold, it is
agreed that:
1. Rt. no t.ime u~l! there be erected on the premises a
st. ructure to be used For residential puPposes,
2. None oF the boats moored o~ docked a[ [he p~emises
shall be used For resdLden~lal purposes, ~.e., sleeping aboard
overnight, ~xcept thm~: t~ans~ent users oF boat sl~ps may stay
on the:LP bo~ts oue~night prouided [hei~ use is occasionai and
no[ regular.
~. Th:is couenant ~s cre~ed For the benefit oF ~he To~n
oF Sout.hold and all presenk ~nd Future resident.s oF the Hamlet
oF Ne~ SuFF.olk, so long as they remain residents.
a condit.ion oF t.he approval oF the site plan For
couenant.ed and
2105C/1
Town Trustees o£ t~e Town of Southol~
Soutaold Town ~all
~out~iol~, i~ew ~ork 11~71
Dear ~rus tees
wish to outline
~,~arcb 20, 2002
F~: Public hearing
~arch 20, 2002
L~we Lane Acquisition Corp.
11'?.-d-18
a number ~e~f-concerns a~out the iiayners' proposal
to expa~ tacit marina. AS you know, we in ~ew Saf£ol~ have travele~
t~is romte before. ~any of my concerns are ~ae same as those ex-
pressem in 19o6-~7 in regare to tr~e then-propose~ 2arina ~ay Clu~ --
questions equally valid toeay.
1 ) What will ue tr, e e£~ect bi' the bulkheading an~ aoe~ extensions
on t~e stability or the remaincer of she ~ew Su_fl'olk shoreline
to t~e nert~l, south, and west?
2) Since all construction woul~ ~e wit~in a ~esignate~ floo~ plain,
w~at woul~ ~e t~e impact o£ site elevation on storm run-off into
b~e Say anm onto tko surrounming uplan~ areas?
3) Prior use bi~ the uplani ana unaerwaZer properties as a marina
and submarine base is 0eliewe~ to kawe resulte~ in contamination
of both. ~aat will ~e the effect on marine life o.f the iispersion
of toxic metals in She water ~uring ~redgi~g operations ani during
uplarm construction? ~ew soil tests are needed for the presence
on t:~e marine ~ottom an~ uplan~ of heavy metals anl pesticide
resi~iues. To my ~nowte~te there has ~een no enviro~ental olean-
mp of tc~e properties.
4) are any uneer~roun~ l'uel storage ta_n~s proposee? if so, what are
ir~e aazar~.s in a ti~lal flood plain? What are the plans to hanile
possible accidental fuel spills at the doe~s an~ within the boat
storage builiing?
5) ~ha.t is t~e propose~ sewage treatment system? Site-specifio con-
eitions include tidal influence, a ~igh water table, an~ prior
landfill, ii' lea. er. lng pools are planne~, what amount of rainfall
is the system ~e.signei to handle? What will prevent excess storm-
water overflow into t~e Oay? What wo-~_l~ De the effect of wiie
seasonal variations in the waste stream flow? Eave t,~ere ~een
percolation tests an~ soil ~orings taken on site to eetermine
what loa~ the groun~ would '~e able to aan~le? ¥~aat woul~ ~e the
effect ozs. groumdwater flows in the area?
6) t~ow muc~ light spillover woull there De onto t~e surrounding
hamlet, t~e Day, and t~e opposite resieential shore?
7) ~hat wo~li be t~ze noise impact of operational mec~anical systems?
Does the projecte~ operation include sal'eguar~s against regular
or continuous li~e-a~oar~ resilience on ~oats, i.e., floating
con~osY
~ l-~ow coul~ our narrow s~reets aha limited par~in~ absor~ more tr~an
~ou~le the zrafYic?
Town Trustees
page 2 1~,arca 20, 2002
~'inally, with re~ar~i to underwater ownership, does the uplani owner
in fact own t~e entlre underwater ~rant area? While the 183U grant
Oy ~,~ew Yor~ ~tate to t~e uplan~ owners appears to oe valid, it ~oes
include a condition: unless "all an~ every part" o£ tae premises
were applie~ "to the purposes of ¢om~:erce, ~y ereeting Do~s ani
~harw'es t~ereon, an~ i'illing in t~e same," the grant of the mnuse~
portion woul~ ~e caneelei, is it possible taat less than 'aalf the
~ew Yor~ orate grant area has overstate years oeen utilize~ oy tae
uplanm owners?
In view oi all taese concerns, surely a new En~iro~amental Impact
~tatement must be a requirement.
I£ some ol' these issues fall within the jurisr~iction of ott~er
Boar~s or a. ge~eies, i sm~mit taat the overriding concern for the
efi'eet on t~e hamlet and on the Bay shoul~ Oe a factor in your
consiaerati OhS.
1 nope t~e Eaynors' marina an~ l~ew Sui~oli~ can success£ully co-
exist, x su~mit tais woulm nave to mean fewer boat slips an~ 0oats,
i'ewe~' cars ann parking spaces, an~ an office building that ~oes not
bloc~ t~e foot o~' tae main street in the ~iamlet with its direct
view oi tae oay. i would nope taat some consideration could 0e
given to public access.
2002 is not 1~87. z.~owewer, some taings remain tae same. i quote
a neighbor from t~at time:
"in some measure i, ew 5ufl'olk could ue said to nave extremely
low zflres~old levels which would to its inhabitants signal
a perception oI pollution a/l~ deterioration."
Our h~mlet is very precious to us ano we wis'n to protect it.
Tha~m [~ou I'or 3our attention.
~ery truly yours,
~n ~o~ins
lb9~5 ~ain ~treet
~ew Jufiol~, l~ew ~ork 119~6-014~
March 15, 2002
Southold Town Board of Tru,.stees
Town Hall
Southold, New York
Re: COVE VIEW MARINA
SCTM# 117-8-18
I Dear Members of the Board,
The New Suffolk Civic Association organized a public meeting at the School in New
Suffolk last fall for the purpo~e of discussing the above referenced project, and
approximately sixty people from the community attended. The sponsors of the project,
Henry and Mike Raynor, were kind enough to present drawings and answer questions
from those in attendance. Sintce that time there have been many discussions about the
project in New Suffolk, and there remains serious interest. Other projects have been
proposed for this site in the past, and the residents question if this, finally, is the right
project for the community. The Civic Association has offered to communicate their
concerns to the relevant regulatory agencies, such as the Board of Trustees. In addition,
you can expect to hear from many New Suffolk residents in person.
Although significantly scaled back from the Marina Bay Club application of fifteen years
ago, and the condo project be fore that, many of the environmental issues are the same.
There is concern that the proposed construction, which extends far out into the Bay, will
affect the local ecology, particularly the natural movement of water and sand. The site is
at the edge of the North Race, a narrow strait between Robins Island and the New
Suffolk. Strong tidal currents move through the Race, and move significant amounts of
sand along with them. Residents with long experience on the Bay have noted long term
changes in the local sand bars. Of particular concern is a shoal located a few hundred
yards off the point of New Suffolk, which has seemed to grow in recent years, and
become shallower. How would the proposed project affect this condition and the
navigable waters in the immediate vicinity?
There has also been much discussion about how the project will affect the "littoral drift"
of sand along the shoreline. Sand appears to move from west to east, from the shore of
Great Peconic Bay to that of Cutchogue Harbor, past the project site. There is already a
deficit of sand along the eastern beaches of New Suffolk, from the end of Orchard Street,
to well past the Old Cove Yacht Club at Old Harbor Road. Beaches along this shore have
eroded, in part because sand is trapped by the current breakwaters on the project site.
Would not a larger breakwater, projecting further out into the Bay, block more
sand from nourishing this beach? Could worse erosion occur?
NEW SUFFOLK CIVIC ASSOCIATION, INC. POST OFFICE BOX 642 NEC,' SUFFOLK, NY 11956
The construction process itself raises some concerns. What will the effect be of dredging
potentially contaminated material from the bottom of the existing boat basin? Similarly,
the upland soil has been suspected of contamination for many years. Will samples of
both the basin bottom and the upland soil be collected and tested as part of your
review? If contamination is found, what level of clean-up will be a condition of your
approval?
Several people have expressed the concern that adequate steps be taken to prevent new
contamination of the Bay and groundwater from the operation of the marina. The facility
may end up functioning as a "dock-ominium", (live aboard yachts), which will lead to a
greater concentration of impacts. We know there are stringent regulations governing fuel
storage and sanitary waste collection and disposal. Will you be diligent in your review
of the design and operating regulations of these facilities?
Since a large part of the project involves construction on underwater land, we
wonder if sufficient documentation of continuing title to that land (1838 grant) will
be required?
Many people have expressed the opinion that the new office building and chandlery, as
proposed, will be in the wrong spot. The fact that it will block the view of the Bay from
Main Street may not be one of your chief concerns. However, is it not an issue that the
building is far closer to the wetland edge than the typically required 75 feet?
The site has been an active port, shipyard, submarine base, commercial center, and
marina for over a hundred and fifty years. It has played a central role in the history of
New Suffolk. The ravages of time have brought serious deterioration to the site. Most
people in the community who have spoken with us are in support of improvements,
however, everyone agrees that the "improvements" must not cause un-intended
environmental, social, or economic consequences, which will be regretted long into the
future. In your thorough evaluation of this application, please seek answers to these
important questions, and remain open to input from the community.
Respectfully,
Thomas C. Samuels
President, New Suffolk Civic Association
Cc: Henry Raynor
373
OCT-2D-2BD1 12:37 NAT[~L LAND TENURE
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0CT-29-2001 12:38 LRND TENURE P.04/04
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0CT-29-2001 12:57 NRT! LAND TENURE
NA' ~NAL LAND TENURE
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0CT-29-20~1 12:313
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NRT~qLL~D TENURE
P.04/04
/
AJhert J. Krupsld, President
James King, Vice-President
~t ~,~ 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
Coastal Erosion Permit Application
...5"Wefland Permit Application JMajor
· Waiver/Amendment/,Changes
_,~'Rece~ved Applicafio '~c~
eceiv ree:
Completed Appli~ ~ff6'fi~
Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination: (date sent)
~CAC Referral Sent: )
_~2Date of Inspection: I
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
.?ublic Hearing Held:
Resolution:
Minor
Name of Applicam
Address
~/~qT~ 'i-t_~ ~k. c~-Xl. 11 ~honeNumb~:( )
S~olk County T~ Map Number: 1000-
Prope~ Location:
~rovide L~CO Pole ~, dismc~ to cross stre~s, ~d location)
AGE~:
(~ applicabl0
Address:
Phone:
Board of Trustees Application
Land Area (in square feet):
Aa-ca Zoning: '~
Previous use of property:
Intended use of property:
GENERAL DATA
Prior permits/approvals for site improvements:
Agency Date
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency.9
x~ No Yes
If yes, provide explanation:
Project Description (use attachments
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: R~rRO wF__= ~[~ ~ ~ c..~)-
~o~kt~6,~'l~ ~'T~l~u~.~ ~t~T ~l~ ~ ~
~e wetlands present M~n 100 f~ of the pro~s~ a~Mty7
~ No Yes
D~s the proj~ involve ~x~vation or filling?
No ~ Yes
If Yes, how much matenfl mil be ex~vat~?2~ .(cubic ywds)
How much matefifl ~1 be filleq? (cubic
Manner in w~ch material ~11 be removed or de. sited: ~c-Tfl
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
t
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
STATE OF NEW YORK
COUNTY OF SUFFOLK
~Nf-~ ,E.. ~E~ ~./~',,t,.ol~ , residing at
~-~T~k 1¥-~7'. , being duly sworn, deposes and says
that on the ~-~x day of ~E W ,~9~ , 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 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 ~If~ ~ ~%~ ~q,¥, , that
said Notices were mailed to each of said persons by (certified)
~ _ ~ ~_~ mail.
Sworn to. before me this
day of ~J~-~ ,~ %
Notary Public
MFJ.AN~: V. BA~
617.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I~PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT I~ I 2. PROJECT NAME
3. PROJE~ LOCATION:
4. PRECISE LOCATION {Street adS,ess and road inters~tions, prominent landmarxs, etc.. or ~ovioe maD)
5. IS PROPOSED ACTION:
[] MoclificationlaJt erst ion
7. AMOUNT OF LAND AFFECTED:
Initially ~ acres Ultimately ~ acres
a. WILL PROPOSED ACTION COMPLY WiTH E;(ISTING ZONING OR OTHER EXiSTiNG L.~NO USE RESTRiCTiONS?
~,¥es [] No If NO. describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
[] Residential [--~,!ndustrial ~t~Comrnercial
Describe:
[] Agriculture
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE OR LO(AL)?
[] No tf yes, list agency(s) and permit/ApprovalS
11. OO~S ANY ASPECT OF THE ACTIOM HAVg A CURRENTCY VAUD PERMIT OR APPROVAL?
~ Yes' ~ NO If y~, list ag~ llama and pe~iUapproval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE ~4OOIFICATION?
t{::l~Nd . ";'
Yes
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE iS TRUE TO THE BEST OF MY KNOWLEDGE
if the action'is in the Coastal Area, and you are a state agency, comptete the
Coastal Assessment Form before proceeding with this a._~essmeot
OVER
!
PART II--E,,NVIRONMENTA' '$~I~hlE,,"~T ~To be comole:eQ ~y AGaric'
PART Ill--0ETERMINATION OF SIGNIFICANCE (To be completed by Agency)
Chec.~ :his box if you have idenrifieP one or more potentially large or significant adverse imoac:s which
occur. Then ~roceed direc:ly ~c :ne FULL E.AF Analor prepare a positJv~Qeclaradcn.
Check [his box ff you ~ave de[ermineO, based on the information and analysis ~bove and any supoortin~
documentation. :h~[ ;he proooaed ac:ion ~,VILL ClOT result in.ny significant adverse environmental
A~NO provide on ~tsc~ments aa necsssary, the reasons supCordng mis determinsdon:
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
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
In the Matter of the Application
COUNTY OF SUFFOLK) w
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I,~{ ~. i~7~ , residing at ~?Z C~l~6t b~l~
belng duly sworn~ depose ~nd say:
That on the~} ~ day of ~¥, 200~, I personally posted the
property known as ~c~ ~ ~\~\~ ~ ~.
by placing the Board .of Trustees ~fficial 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 the
~ublic hearing. Date of hearing noted thereon to be held~/~
Dated:
(signature)
Sworn to before me this
Notary Publi~
TRANSACTIONAb DISCLOSURE FORM
The Town e~ S~hold'e Code of Ethics prohibits conflicts
interest on the part of town officers and employees. The
purpose of this form is to provide ln£ormation which can
alert the town of possible conflicts of interest end"allow
ib to bake whatever action is nec~essary to avoid same.
(bast , ~i~t name, m~dd.le ~n~t~al, unless
you are applying in the name of someone else or
other entity, such ~s a company. ~ ac, indicate
the other person's or company's name,)
NATURE OF APPbI~ATION~
(Check all that apply.)
Tax grievance
Variance
Change of zone
ARp~val of plat ]<. ~ .
gxe~phion from plpt or official map
employee o~ the To~n of Southold? -Re~a~tonehip"
by blood, marriage, or business in~eree~.
~hfch ~he eo~n o~ieer or employ&e hue even a pareiai
ownership off (or employmen2 by) a eorp~raBion in vhiclt
She ~oVn officer or employee o~na more ehan
shares.
YES__ NO , :
da~e and sign ~here
Name of person employed by the To~n of Southold
Title or position of that person
Describe the relationship between yourself (the applicant)
and the town o~icer ~r employee. ~ither check the
appropriate line A) through D) and/or describe in the space
provided.
The town officer or employee Or tits or her apouee~'
parent, or child ia (check all that apply)~
A) the owner o~ greater b~an 9% of the shares o~ the
corporate stock o~ the applic~nt (when the applicant'
is a corpora~ion)~
~) the legal or beneficial owner o~ any interest in a
noncorporate'entity (when time applicant is not a
corporation)l
__C) an o~icer~ di:rector~
applicant~ or
D) tbs actual applicant.
pa~tner~ or empl0yee, of the
DESCRIPTION OF RELATIONsIIXP