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1000-45.-2-10.2
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OT 1 Pipes COVBN ° 141 7\ ¢blloh is H¢+6a ¢ ~w: ,.`` , t . �,. . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . A ...` A . . .' .'.'. . . . . 5 // LOCATION MAP . . . PROPOSES SCALE 1" = 2000 . . . . .. . UTILITIES LOT 2 . . . . . . . . . . . . . . . ..'.'.'. ; '. . . .'.'. .'. .'.'. . .. . . . . . . . . . . . . . . . . . . . . EASEMENT . .'. . .'.",, .'.', . . . . s. . . . . . . . N' .'.' N . ° >3 . . . .. . . . .' . . .. . .to.. 0 / N J . . . . . . . . . . . . . . . . . . . 1 . . y'. . c A.T / rn . . . . .. . . 5� 1 W s TI_a / 5 36. '3,. 0 32 / Ur .. . .1,. W S 4 3.3 2 2 N. '.'. / 451 . . . . . . . .L , / . . . . . . . GN Q' / 1B / aL / o LOT 10 3 I IV / CO/ \ 20 r JL ' / I RESHWATER 1 - _— WETLAND FRESHWATER �� I / L WETLAND \ �,� /\ —W- I \\IW i S 2'30" W _ 274 9 — — — I —5 38'32'30" W — —2 4 77 — I� N I LOT10.2 I LOT 8 / I \ LOT 71 z/ �O ° Iw I �20 / CHURCH I I 11 STY. I / BUILDING II I \ I m I I \oo 34 35' S 8'32'30" 9 269 59 00 0 _ 50 350.66' _ 21.24' 3� M IN ROAD (ROUTE 25 ) �\ 11 Y Desi ned B PFo ect No 9 NFBC 92-01 �' — q ARTM NORTH FORK BANK & TRUST q DOWeKAK PAP DWG p i Checked BY s,ele;, — 60, PROPERTY SITUATE AT /✓ ReV1eWe D01e SAN SIMEON RETIREMENT COMMUNITY NOTES' AREA OF PARCELS: LEGEND ,I o MARCH ,993 Revleon, GREENPORT, NEW YORK 1. NYSDEC FRESHWATER WETLANDS BOUNDARY NURSING HOME: 155,999 SO. FT. OR 3.581 AC. WETLAgPS TOWN OF SOUTHOLD, COUNTY OF SUFFOLK, AS DELINEATED BY K.C. KELLY AND PARCEL TO BE 287.241 SQ, FT. OR: 6.594 AC. �� SECTION 45, BLOCK 2, P/O LOT 10.3 R. JACOBSON ON SEPT. 13, 1992 CONVEYED: s EXISTIEG SANITARY UNE 2. METES AND BOUNDS ARE THE RESULT OF OVERALL PARCEL: 1,635,914 SO.- FT. OR 37.555 AC. 2MG OUP A COMPILATIONDBO D DEEDS AND A MAP W EXISTING WATER SERVICE t,Lav New 516-756-8000 ■ ENTITLED 'SURVEY FOR SAN SIMEON �.rv^ o RETIREMENT COMMUNITY' BY YOUNG & YOUNG REMAINING AREA: 1,348,673 SO. FT. OR 30.961 AC. �w�° r eat-zs6-sa:;a ❑ 1p EXISTING CONTOURS * a ' ; t- 3. EXISTING WATER, SANITARY AND BUILDINGS U7IUTIES EASEMENT: 17,252 SQ. FT. OR 0.396 AG. Ho 3. McLendon & Murrell, P.C. AS SOWN HON MAP ENTITLED "SURVEY FOR CONSULTING ENGINEERS ARCHITECTS • PLANNERS SCIENTISTS SURORS SAN OWN RETIREMENT COMMUNITY BY PARIEL TO BE CONVEYED • • • VEY 'a' D a�' ?� MELMLLE, N.Y. TOTOWA, N J y YOUNG & YOUNG °RnF III;'4' Sheet Sheet Title: -urzB.nw vv mu oocwr[xr. [r¢vr er 5 PARTIONING MAP 1 OF L uo vBasEsvnxu Is lucai• N PLANNING BOARD MEMBERS T SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman /,r O�� Supervisor George Ritchie Latham, Jr. �Oj Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 June 15, 1993 Joseph Fischetti, Jr. , P.E. Hobart Rd. Southold, NY 11971. Re: Proposed lot line change for San Simeon Retirement Community & Nursing Home County Rd. 48, Greenport SCTM# 1000-45-2-2 & p/o lot 10.3 Dear Mr. Fischetti: The following took place at a meeting of the Southold Town Planning Board on Monday, June 14, 1993: The final public hearing which was held at 7: 35 P.M. was closed. The following resolution was adopted: WHEREAS, the San Simeon Retirement Community, Inc. is the owner of the property known and designated as SCTM# 1000-45-2-2 & p/o lot 10. 3 , located at the northeast corner of Rt. 25 and Chapel Lane in Greenport; and WHEREAS, this lot line, to be known as proposed lot line change for the San Simeon Retirement Community, Inc. is for a lot line change to subtract 6,594 acres from a 37. 555 acre parcel and add it to a 3 . 581 acre parcel; and WHEREAS, the Southold Town Planning Board, pursuant to the State Environmental Quality Review Act, (Article 8 ) , Part 617, declared itself Lead Agency and issued a negative declaration on May 24, 1993 ; and Page 2 San Simeon lot line change June 15, 1993 WHEREAS, a final public hearing was closed on said subdivision application at Town Hall, Southold, New York on June 14, 1993; and WHEREAS, all the requirements of the Subdivision Regulations of the Town of Southold have been met; and be it therefore RESOLVED, that the Southold Town Planning Board approve and authorize the Chairman to endorse the final survey dated March 1993 . Enclose please find a copy of the map which was endorsed by the Chairman. Please contact this office if you have any questions regarding the above. c ly, p �j ��fichard G. Ward�%/ Chairman enc. Cc: Building Dept. Assessors Office s SAN SIMEON RETIREMENT COMMUNITY, INC. Chapel Lane Greenport, New York 11944 April 5, 1993 Southold Town Planning Board Town Hall Southold, New York: 11971 Re: San Simeon Lot Line Change Gentlemen: The following statements are offered for your consideration in the review of the above referenced lot line change. The undersigned, being the owner of 37 .5 acres, more or less, located on C.R. 25 (North Road) , Chapel Lane and Main Road, Greenport, and known as San Simeon Retirement Community, requests the proposed lot line change be approved. The parcel to be affected by the lot line change consists of approximately 6.5 acres adjacent to the San Simeon Nursing Home Facility, and fronts on the North Road. This parcel was not included in the San Simeon Retirement Community Site Plans for development for residences, but was always considered as set aside for future expansion of the Nursing Home Facility. At this time San Simeon by the Sound, Inc. , which intends to purchase the nursing home facility this year under the terms of its present lease, confirmed its on-going interest in purchasing the 6. 5 acre parcel which surrounds the nursing home. Upon receipt of the Town's approval, it is anticipated the parties will enter into an agreement, satisfactory to both, for the conveyance of the 6. 5 acre parcel to the Nursing Home Facility. Your applicant agrees that a condition of closing will be that an affidavit be executed by the adjacent owner and delivered to the Town of Southold to the effect that the 6.5 acre parcel will be merged with the property which now constitutes the Nursing Home Facility. Southold Town Planning Board Page Two The undersigned understands and agrees that if the 6. 5 acre parcel is not: conveyed to the adjacent owner of the Nursing Home Facility, then this approval of a lot line change will be null and void and of no further force or effect. Your attention to this request is appreciated. San Simeon Retirement Community, Inc. By STATE OF NEW YORK;) ) . :ss COUNTY OF SUFFOLK) On theday of April, 1993, before me personally came WiIha. w. R sc6. to me known, who being by me duly sworn, did depose and say that he resides t Soso I N y ; that he is the - of (kn irvw >n which executed the foregoing ins'trument,--...:* - r-#�tei�si�a-coal f �a f r-r 4xed-t ) SaidInstrument is etteh-eQzporate order of the Board of Directors of said corporation, and that he signed his/her name thereto by like order. Q" c Notary Public ANTOINETTE BOAZ Notary Pubblico.4 tate 01 Ne"York Qualified in S4 rtk CourdV Commission ExPires q� 114-16.4(21871—Text 12 PROJECT I.D. NUMBER 617.21 SEOR 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) APPLICANT O SOR 2. PROJECT N15.9MVE 3. PROJECT LOCATIONGrea+� Ur1 ` County 5-Pr4A / r Municipality 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc.,or provide map) Noe- nta�- Cur . o- 2+ 2 4 Ch*llo)e �4" 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: IN6f L/n2 7, AMOUNT OF AF �— Initially acres Ultimately acres S. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? QYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? aResidential ❑Industrial El Commercial El Agriculture C1Park/Forest/Open space ❑Other scribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAQ?? ` ❑Yes )(No If yes, list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes til No If yes, list agency name and permit/approval 12. ASA RESULT O\PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? - ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE e�/1 Applicant/spons r e: s T. PE l Dale: '7• �� d SEPri rise=;rr, :11. Signature: PROFESSIONAL iP`iG cR r1 i the action is in the Coastal Area, and you are a state jjjoj� comCoastal Assessment Form before proceeding with thes of OVER PLAN PART II—ENVIRONMENTAL ASSES•�ENT (To be completed by Agency) A. DOES ACTION �rEED ANY TYPE I THF. AOLD IN 6 NYCRR, PART 617.12? It yes,coordina .,1e review process and use the FULL EAF. ❑Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: lV C). C2. Aesthetic, agricultural,archaeological, historic, or other natural or cultural resources;or community or neighborhood character? Explain briefly: N o. C3. Vegetation or fauna, fish,shellfish or wildlife species, significant habitats,or threatened or endangered species? Explain briefly: IV O. Cd. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly. NO. C5. Growth, subsequent development,or related activities likely to be induced by the proposed action? Explain briefly. YES - POSSIBLE.: 'EXPANSION OF Exis-riNtzr NURSIM,La �IDME FAc )LdIF.s . C6. Long term, short term, cumulative,or other effects not identified in C1.C5? Explain briefly. N D. C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. No. DMS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes VXNo If Yes,explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) -INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse Impacts have been identified and adequately addressed. ❑ 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 this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the-reasons supporting this determination: Name o Lead Agency Print or Type Name or Responsible Officer in Tead Agency �--� Title of Re po ible O icer Signature or Responsible Officer in Lead Agency - � )5(gnatere of Prepare((it different from responsible officer) Dates 2 s APPLICATION FOR APPROVAL OF PLAT To the Planning Board of the Town of Southold: The undersigned applicant hereby applies for (tentative) final approval of a subdivision platin accordance with Article hi of the Town Law and the Rules an egulations of the Southold Town Planning Board, and represents and states as follows: 1. The applicant is the owner of record of the land under application. (If the applicant is not the owner of record of the land under application, the applicant shall state his interest in said land under application.) 2. The name(of the subdivision is to be . . . .. . . .. .. .. . . . . . . . . . . .. .. . . . . .. . . . . . .. . . . . ... . . . . . . . . .. .. . . .. .. .. .. . . .. .. .. . . .. .. . .. . ... .. .. . ... . . . .. . . . . . . .. .. .. . . . . . . . . .... . . ... . . . I . . . . . . . . . . . . 3. The entire land under application is described in Schedule "A" hereto annexed. (Copy of deed suggested.) 4. The land is held by the applicant under deeds recorded in Suffolk County Clerk's office as follows: gS70' 69?. . .. . . . . . . . On . . S/,73r�d'g Liber . . . . . . .. .. .. . . .. I . . . . . . Page . . . .. . . .. . . . Liber .�. . !.. . . .. .. . . .. . Page . . �+�./. . . . . . . . . . . . On . . . • • 3./73.. . . . . ; Liber . . . .. .. . . . . .. .. . . .. . . .. . Page . . . . . ..... . . . . . . . . . .. . On Liber . .. . . .. . . . . .. . . . . .... .. . Page On Liber . . . . . .. .. .... . ..... . .... Page . . . .. . . .. . . . . . . . . . . . . . On as devised under the Last Will and Testament of . .. . . .. .. . . . . . . .. . . .. . . . . .. . . .. .. . . .. . . oras distributee . .. . . .. . . . . ...... ...... .. . . . . . . .. .. . . . . . . . . .. .. .. . . .. .. .. ........ . . . . .. . . . . . . . . .. .. .. .. . . . . .. . . .. . . .. .. ...'...... ..�...... . . . . . . . . . .. . . , . . . . . .. .. .. . . .. .. . .... . . .... . . . . . . 5. The area of the land is .!./. .,.`�{. .. . . .. . acres. (PYIDN/D 44kw Ci"e) 6. All taxes which are lien Ion the land at the date hereof have been paid except . . . . . . . . . .. . 92.79.?.. . . .. . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . .. . .... . . ... . . . . . . 7. The land is encumbered by FIe mortgage (s) as follows: (a) Mortgage recorded in Liber . .. . Page . . . .6.J. . . . . .. . . . in original amount of $1 !qCD000 • unpaid amount $ . . . .. . . . . . . . . . . . . . . . . heId'Lby /YCr-,f 1y f 3/JHle- address . ...9UZS Mt}/� RbA9 /. Mot#�iJC. .( Alr NS-Z (b) Mortgage recorded in Liber . . . .. . . .. Page . . . .. . . . . .. . . . . . .. . . . .. in original amount of . . . .. . . . . . . .. . unpaid amount $. .. .. . . . . . . . . .. . . .. .. . held by . . . .. . . .. . . .. . . . . .. . .. . . . . . . . .. .. . . . address . . . .... . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. . . . .. . . . . . . . . ... (c) Mortgage recorded in Liber . . . . . . . . . . . . . . Page . . . . . . . . . . . .. . . . in original amount of . . . .. . . . . .. . . . unpaid amount $. . . . . . . . .. . . . . . . . . . . . held by . . . .. . . . . . . . . . . . . .. . . . . .. .. .. .. .. .. . . . . . . .. . address . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. .. . . . . . . . . . . . . . .. . . . . . 8. There are no other encumbrances or liens against the land except . . . . . .. . . . . .. . . . . . . .. . . . 4/& 77V. . . . . . . . . . . . . . . . . . . . . . . .. .... .. .. ..... .. . . .. ... . . . . 9. The land lies in the following zoning use districts . . . . . . . . . .. .. . . .. .. .. . . .. .. .. . . .. .. . . . . . .. .. . . . . .. .. .. . ... . .. . . .. . . . . .. . . .. . . . . . . . . . . . . .. .. . I .. .. .. I . .. . . . .... . . .. .. . . . . . 10. No part of the land lies under water whether tide water, stream, pond water or otherwise, ex- cept . . . .. .**).4 . . .I.S. .4.0. 41+.. . .an. . i/1'.k.. . . . . . . . .. . . .. . . .. . . .. .. . I. . . . . .. . . . . . . . . 11. The applicant shall alJiis expense install all required public improvements. 12. The landCO e SJ)(does not) lie-in a Water District or Water Supply District. Name of Dis- trict, if within a District, is . . . .. 0#Jov. . . . . . . . . . . . . . . ... . . . . . 13. Water mains will 'be laid by . . . . .O&J"e.0.A. ... . . . . . . . . .. I. .. .. . I . . . . .. . . .. . . . . . .. . . . . .. . and (a) CO)charge will be made for installing said mains. 14. Electric lines and standards will be installed by . .. AP/co . . .. . . . . . . . . .. . . . . .. . . . . . . . .. .. . ... . .. .. . . .. . . . . . . . . .. . . . . .. . . . . . .. . . . . . and (a) CnJo charge will be made for installing said lines. 15. Gas mains will be installed by . . . . . . . . .A/6 "ep.. . . . . . I . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . . and (a) (no) charge will be made for installing said mains. 16. If streets shown on the plat are claimed by the applicant to be existing public streets in the Suffolk County Highway system, annex Schedule "I"' hereto, to show same. 17. If streets shown on the plat are claimed by the applicant to be existing public streets in the Town of Southold Highway system, annex Schedule "C" hereto to show same. 18. There are no existing buildings or structures on the land which are not located and shown on the plat. 19. Where the plat shows proposed streets which are extensions of streets on adjoining sub- division maps heretofore filed, there are no reserve strips at the end of the streets on said existing maps at their conjunctions with the proposed streets. 20. In the course of these proceedings, the applicant will offer proof of title as required by Sec. 335 of the Real Property Law. 21. Submit a copy of proposed deed for lots showing all restrictions, covenants, etc. Annex Schedule "D". 22. The//a��pl!p icant estimates that the cost of grading and required public improvements will be $. . . ... as itemized in Schedule "E" hereto annexed and requests that the maturity of the Performance Bond be fixed at . . . 111. ,. . . . . . years. The Performance Bond will be written by a licensed surety company unless otherwise shown on Schedule "F". DATE . .17.C3Y. .1. . .. .. . . .. . . .. .. .. 19. 3 9031�0� h5cl�eTTiJr C/3..oM�� (Name of pplicant) By .r19;7r- .. . .. . . . .. . .. . . . . . . . .. . (Signat re / 172 /Poo Se4)Aj �p . . . .. .. . . .. . . ... . . . . . . (Address) STATE OF NEW YORK, COUNTY OF . . . . �� .�.�, . . . . . . .. ss: On the . . . .!4:.`.. . . . . . day {of. . . .. . . `. . . f.! �.. . . . . ., ., 19.85., before me personally came J. OS2�O 1� t ,'e 1� ( V` to me known to be the individual described in and who executed the foregoing instrument, and acknowledged that . )"I.Cx. . . .. . executed the same. ELIZABETH ANN NEVILLE Notary Public,State of New York No.52.8125850•Suffolk CountvL(jrt�, Term Expires October 31, 19 . . ...?e Notar Public STATE OF NEW YORK, COUNTY OF . . . . . . . . . . . . . . . . . . . . . .. . . . . . ss: On the . . . . . . . . . . . . . .. . day . . . .. .. . . . . . of . . . . . . . . . . . . . .. 19. .. .. ., before me personally came . . . . . . . . . . . . . . . . . . . . . ... . to me known, who being by me duly sworn did de- pose and say that . . . .. . . .. .. . resides at No. . . . .. . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . that . .. . . . . . . . . . .. . . . .. . . . . . . . is the . .. , . . . . . . . .. . . . . . . . . . . I. . . . of . .. . . .. . . . . ... . . . . . .. . . . . .. .. . . . . . . . . . . .. . . . . . . . . .. .. .. . . . . .... . . ...... . . . the corporation described in and which executed the foregoing instrument; that . .. .. .. . . .. . knows the seal of said corporation; that the seal affixed by order of the board of directors of said corporation. and that . . . . . . . .. . . . signed . .. .. .. . .. . .. . name thereto by like order. . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .. . .. . . . ..... ... . Notary Public 1446-4(2/87)—Text 12 •. PROJECT I.D. NUMBER 617.21 SEAR 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) APPLICANT O SOR 1 2. PROJECT N5� E S lA"W" �Jr KAl*4- 4r►•,«?!M lm-e /CirAow 3. PROJECT LOCATION: OrrC " dM� County So I'1'O[� Municipality 4. PRECISE LOCATION(treat address and road intersections,prominent landmarks,etc.,or provide map) AlveA £oral' Ofr . e4:' R+ z5- r ,� chmp/t �4"-1 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration- 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OFJ�j AF r— Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? Ayes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other ascribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)??�1' . ❑Yes I1C7 No If yes, list agency(s)and permit/approvals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes BN No If yes, list agency name and permit/approval 12. AS A RESULT O\PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes NO I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE JJ Applicant/spons r e: s (/"�' " � `� Date: � 7 [� J S�P'r9 r•I �.., ..� Slgnature: r:C PRC °;cL -L2 the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 PLAY'NINUt7B'0ARD TOWN 0 SOU HOLD SUFFOLK-'�O�T,, TY Southold, N.Y. 11971 (516) 765-1933 QUESTIONNAIRE TO BE COMPLETED AND SUBMITTED WITH YOUR APPLICATIONS FORMS TO THE PLANNING BOARD Please complete, sign and return to the Office of the Planning Board with your completed applications forms . If your answer to any of the following questions is ves, please indicate these oTr your guaranteed survey or submit other appropriate evidence. 1. Are there any wetland grasses on this parcel? Yes No (Attached is alist" o-f the wetland grasses defined by the Town Code, Chapter 97, for your reference) 2. Are there .any other premises under your ownership abutting this parcel? Yes NO 3. Are there any building permits pending on this parcel? Yes No 4. Are there any other applications pending concerning this property before any other department or agency? (Town ," State, County, etc. ) Yes No 5. Is there any application pending before any other agency with regard to a different project on this parcel? Yes No 6 . Was this property the subject of any prior. application to the Planning Board? Yes No 7, Does this property have a valid certificate of occuparicy, if yes please submit .a copy of same Yes No 4onfyathate a ve tatoments are true and will be relied t eg B and n consdering this applicat 'on'z4a ureerty owner or au-t-- orYzcd agent date JOS,"i, r: ! = .. PROF,4S-I i pry, z " southold, N. Y. 11971 Attachment to questionnaire for:.-the Planning Board STATE OF'NEW YORK, COUNTY OF SUFFOLK, ss : On the ��-/h day of I r1 19�, before me personally came_ -o�pTh -F �S GYM , ��• to me known to be the individual described in and who executed the foregoing instrum and acknowledged that X12 executed the /s�ne. No ry Public ELIZABETH ANN NEVILLE Notary Public,State of New York No,52-8725850,Suffolk Term Expires We 31, 7 6 i THIS LOT LINE t- -ANGE BETWEEN r' AND IS LOCATED ON IN SCTM* 1000- LOT LINE CHANGE Complete application received ' Y — 73 WL Application reviewed at work session _ 1M10• FOK Applicant advised of necessary revisions Pam Revised submission received 'n ,=- Nro. O K Lead Agency Coordination �z - 13 SEQRA determination 'r—+a�TjT k,C Sent to County Planning Commission a`l 93 11M I Q �no•1 intro. OK Review of SCPC report Draft Covenants and Restrictions received nro. OK rAm L Draft Covenants and Restrictions reviewed UTJOK Filed Covenants and Restrictions received Final Public Hearing f 'y Approval of Lot Line -with conditions Endorsement of Lot Line �1141F:— ms 1/1/90 Southold Town Planning Board Town Hall Southold, New York 11971 Re: pss 9 <a r a cNA/YG E f R .veil Gentlemen: Stili S/hi�a�7 R�TRoE4�fTe�E /'W' A / , SCT�Yt�',oOO^yo$^.Z'� cf P/6LoT/a .7 The following statements are offered for your consideration in the review of the above-mentioned minor subdivision and its referral 'Eo the Suffolk County Planning Commission: (1) No grading, other than foundation excavation for a residential building is. proposed. (2) No new roads are proposed and no changes will be mace in the grades of the existing roads . (3) No new drainage structures or alteration of existing structures are proposed. r trul , i APPROVED BY °�. PLAPJNING BOARD TOWN OF SOUTHOLD S 38'32'3 W \ ATE 21.24' �3p.. 50UTHDLD TOWN PLANNING BOARD Designed By. Project No: NF6C 92-01 NORTH FORK BANK & TRUST Drawn By, Drawing Name' KAK PARTMAP.DWG ;hecked 3y Scale: PROPERTY SITUATE AT 1" = 60' 'eviewed By Date. SAN SIMEON RETIREMENT COMMUNITY MARCH 1993 V1� Revisions: GREENPORT, NEW YORK TOWN OF SOUTHOLD, COUNTY OF SUFFOLK SECTION 45, BLOCK 2, P/O LOT 10.3 OF NE y U2AGROUP 2010 E -256-54- Holzmacher, McLendon & Murrell, P.C. CONSULTING ENGINEERS ARCHITECTS PLANNERS SCIENTISTS SURVEYORS MELVILLE, N.Y. -- - TOTOWA. N.J. 7 °• 0,4�;- �- 'Sheet Title: Sheet_ - pRoat P� T.Darr... PARTIONING MAP 1 OF 1 • 1571(BIFr6E' LAW OFFICES P� WICKHAM, WICKHAM & BRESSLER, P.C. MAIN ROAD, P.O. BOX 1424 MATTITUCK, LONG ISLAND WILLIAM WICKHAM MORTGAGEOFFICE NEW YORK 11952 ERIC J.BRESSLER 516-298-5300 ABIGAILA.WICKHAM 516-298-8353 TELEFAX NO.516-298-2012 LYNNE M.GORDON TELEFAX NO.516-298-8565 JOSEPH C.SAVINO HUBERT F.SULLIVAN JANET GEASA JEFFREY STARR September 13, 1994 Southold Town Planning Board Southold Town Hall Main Road Southold, New York 11971 Re: San Simeon Community Retirement, Inc. Lot Line Change. Art: Mr. Robert Kassner Dear Bob: Enclosed is a copy of the recorded deed for the conveyance of the northerly parcel to the nursing home. Very cordially yours, bigail A. Wickham AAW:mh encl. o � u u SEP § l99& U S%ANNING AWN BOARD iNli IS I HE I I Vi 1)OR I'll IN I ED IN P{LACK INh�V(,�1'RtOit'ro RECORDING OIt FILING. 1 SUFFOLK COON&I,EIrk J 1%523 =RECt�� as I FE&ESTATE Fnnnbrrnfpsgca � ,IAN I3 1994 Serial a TAA'ILFFR TAX '— SUefULK Certificate (WI.Y ='+elf" Uccd f Mortgage Inelnlmcnl Dred/Slnrtgsge Tax Stamp Recording;Filing Stamps + FEES i Page;Filing Fee _ fNnrtgage Amt. Ilandting _ ._ I.Basic Tax Tr•SM �i ,L_ 3.SON VS1A T Notation Sul,Total E,b5117(County) JSub Total 7.Spee/Add. a EA-5117(State) TOT.MTC.TAX 1 0017 //rrDual Town Duat Count -- __ _ h S[�,••,x 91$4 Held for Apportionment ri Comm,of F.J. S . Ila �r1� .tIMLIhrJIy�F � Transfer Tax —I--l=+�= •+' AffidavitY •Q1 Mamilor,Tax Certified Cnpy The property covered by thi.,mortgage IA or rill be improved by a one or loo Itc4 Copy _ Suit Total ,_ family dwelling only. t/ YES, or NO 0111vr _ CRANIA TOTAL� ._ If NO,see appropriate lax clause an page 0—or this Instrument. �a Real Property Tax Service Agency Verification 6 Title Company Information rte, lit - Section Illock Lod � Commonwealth. .y / © Land Title lnsuranceCompany Company Name J -- Ff9� /off Title Number FEE PAID BY: + Cash_Clicck Clurgc__ Pater same as R&It,__ L-A Commonwealth.0It: �- f W C �Q<e �� i4 L:w l Title In.urunce(nmpant -- It71tLlCn,mnyNrvA(Nnne!A) S RECORD RETURN To Nnedv.d.NY 119111 Suffolk County Recording & Endorsement Page 7'llis page forms part of the attached a e'1ecr at� �1 (Decd, Mortgage,ctc.) D _ 1 _ �lnlrnK � trPrw',"7 ThepremitgsherrinisxihlnleJ{n ' SUFFOLK COUNTY,NEW YO � — L 1111 lead In the TOWN of PLANNING i �J In the VILLAGE _ ,"P /t/Lt, � (.a-r ih orIIAMLETof �e-e-7t0 f .., ..,... .,.•n,. .e,..n au ,na ersrT s t C0M11AI YOUR LAWYER eifOet/IAMIMO INIS lN1IRVMtNT—THIS IMIIRV!WOVID 11 111111 eY IAWYI"ONLY. THLS tkDFJflT M nw le the 70th day of June ihmitee hundred and ninety-thiee BET'%T" SAN SIMEON RETIREMENT COMMUNIT'f, INC., a not-for-profit corporation with offices at Cnepel Lane, Greenport. Nev York 11944 y , s�.. 'f party of the first part,and 4 x SAN SIMEON BY THE SOUND NURSING ROME, INC., a not-for-profit com,ration with offices ad North Road, Greenport, New York 11944 party of the second part, WMESSE 4, that the pary of the 6"t part, in consiuernion of--------TF4 AN: 00/100-------------- -_.------__--..------------------($10.00)-.-----------------_-----.-_---_-dollars. lawful morvv of the United States. and ocher gond and ea'uable consideration paid by the party of the second pan, dues here Ly grant and release untr, thr p:r . of the part. th, heirs or setter»n and assigns of the parry of the second part forever, ALL that certain plot, piece or parcel of land, with the b.+ildings and intprosements thereon erected. situate, lying and being jRstke at Greenport, Town of Southold, County of Suf.oik end State of ., New 'fork more particularly hounded and described as follows: Sf,E SCIM)ULE "A" ATTACHEI HERETO t I t )ISTRICT 000 :ECTI ON ;LOCK OT R 6 10.2 t 4 f a i W � t « r , SCHEDULE A ALL that certain plot, piece or parcel of land being at Greenport, Town, of Southold, County of Suffolk and State Of New York more particularly bounded and described as follows: j ( 5; BEGINNING at a point where the north easterly side of Chapel Lane intersects the easterly side of Middle Road, County Road 25 (North Rcad) , running then from said point of beginning along the easterly side of Middle Road the i following two courses and distances; 1. North 50 degrees, 15 minutes, 7 seconds east 27 feet; 2. RUNNING THENCE along a curve bearing to the left having a radius of 749.20 feet a distance of 338.75 feet to land now or formerly of Abraham Shames. a . a RUNNING THENCE along land of Abraham Shames and others the following three courses: 1. South 65 degrees 57 minutes 10 seconds east 400.01 feet 2. North 24 degrees 02 minutes 50 seconds east 390 feet; V �P 3. North 65 degrees 57 minutes 10 .3econds West 400 feet to the easterly side of Middle Road; RUNNING THENCE along the easterly aide of Middle Road 1 North 24 degrees 02 minutes 50 seconds East 50 feet to land now or formally of John Siolas and Catherine Taounis; RUNNING THENCE along said land of John Siolas and Catherine Tnounis South 65 degrees 57 minutes 10 seconds East 460.05 feet; RUNNING THENCE South 06 degrees 06 minutes 30 seconds ,>> West 448.97 feet; RVA'NING THENCE North 69 degrees 91 minute? ?2 seconds East 155 feet; RUNNING THF-';CE South 53 degrees 18 minutes 38 seconds West 136.3 feet; RUNNING THENCE South 23 degrees 39 minutes 21 seconds "i- West 325.54 feet; All ,, i RUNNING THENCE THENCE North '66 degrees 25 minutes 39 seconds West 71.91 feet; RUNNING THENCE South 73 degrees 30 minutes 10 aeconas west 240.61 feet to the Northeasterly side of Chapel Lane; RUNNING THENCE along the Northeasterly side of Chapel ' Lane North 16 degrees 49 minutes 50 seconds west 328.32 feet to the point of place of beginning, being and intended to be those premises an outlined and shown as a portion of the map prepared by Holzmocker, McLendon S Murrell, P.C. dated March i of 1993. .Y Reserving„ however, to the party of the first part it's successors, heirs and assigns the right to maintain, install, repair, replace, and otherwise eervice the usual public utility easements including but not limited to sewer, water, telephone, cable, electricity and gas over, under, along, through and as necessary above a parcel M! approximately 40 feet in width adjoining the premises now or formerly owned by Abraham Shames and more particularly described as follows: 'y BEGINNING at a point on the easterly side of Middle Road, County Road 25 (North Road) which point mar'., the point of intersection of the boundary line between lands now or formerly of San Simeon Retirement Community Inc. and Abraham :,:,., Shames and others; vJ l.w RUNNING THENCE from said point of beginning along land now or formally of Shames South 65 degrees 57 minutes 10 M1i; seconds East 4e9-ei feet; RUNNING THENCE South 53 degrees 18 minutes 38 seconds West 45.85 feet; RUNNING THENCE North 65 degrees 57 minutes 10 seconds West 420.91 feet to the easterly side of Middle Road; RUNNING THENCE along the easterly side of Middle Road in a Northerly direction along the arc of the curve bearing to the left having a radius of 749.20 feet a distance of 40.02 feet to the point or place of beginning. descrip:mtp '�i' t<< s S ' 4� e_ iINN= 1 f a' TOGETHER with all drh;,title and interest,if any,of the party of the first pan in and to anv streets and roads abating the above Cescribed premises to the center lines thereof, ' TOGETHER with the appurtenances and ail the estate and rights of the pariv of the first part in ;cod to Said prnniscs, TO HAVE ADfO TO HOLD the premises herein granted unto the party of the second pan, the heirs or successors and assigns of:he party of the second pan forever. Y ' .alk t i t'.:S :'t rt: I' r f . 'A1 0.M HWeyj .f lssya, eah.s8 hA YW* ywna�gTt pL4 n aM1 fEt1 ,n t AND the party of the first pan covenants that the party of the Ant part hes not done or suffered anythirq whereby the acid premises have been incumitted in any way whatever, except as aforesaid. AND the party of the Arst pan,in compliance with Section 13 of the Lien Law,covenants that the party of n the first part'will receive the consideration for this'eonveyance and will hold the tight to receive such consid• eration is a trust fund to be applied first for the purpose of paying the cost of the Improvement and will apply the amt Ant to the payment of the con of the Improvement before seting any part of the total of the same for any other purpose. i The word"party"shall be construed a if It read"panic&'whenever the sena of this indenture so niq lrn. IN WTINF_SS WHEREOF.the party of the first part has duly executed this deed the day and Sar first above .written. Ire r■uanest orl SRR EIMEON RETIREMENT COMMUNITY, INC.' O v' I � "An OF NIw TOOL Course fit TWO Of MW TOSA,COUNTY r MI. On the " — before me On the day of 19 ,601ore It� • personally asset personally lame a to me known to be the individual dFxnbed in an INT to me known to be the individual described in and who U executed the foregoing Instrument, and acknowledged Ihat executed the fore(oing instrument,.and acknowledged that. executed the same, executed the same, UD A ib.+.l, 1. SY1l..��llI ep ,t? T �M �J ei d. %?Art Of NOW}Ota,COUNTY or SUFFOLK ul STATI Of New Yale,COUNTY Of On the 30th daxuna „r, Ip 93,before me On the day of 19 ,before me personally rime LL, ttyJ[.PJN(tr,AlC. personally came to me known,who,being 1y me duly sworn,dil depose and to me known,who.beim by me duly sworn,did depose and say that be resides at N95 o.7 /3f9`>v )j/. say that he resides at o. that he is the YjdIKa:dti.'faij haallArol it of San Simeon Ra cement Cotmounicys est. that he Is the of ,the corporation described ,the corporation described in and which executed the foregoing instrument; that he in and which executed the foregoing instrument:that be knows the seal of said cerpnration: That the teat affixed knows the seal of said corporation: that the seal a�xtd i to said instrument is In ch corporate seat; that it was eco to said instrument is such corporate sell; that it was to aQixcd by order of the board of directors of said corpora- affixed by order of the board of directors of said eorpon• tion,and thst/he signed In name thereto by like order, tion, and that he signed IT name thereto by like order. y �Y i ( �- OIIDPa tiOIARBLIC V,WnP tAM,State Of MWVA . IM 0-4600t71�NN.r 4 OBONNIaatsra E+il'M Od.fit•1MR�S t. 'Dargaln arab Deli Dull . Wmm CTs-A"?A0a1Y1T Ca.MTaa t ACT arRtON Trill Nt. BLOCK SAN SIMEOR RETIREMENT COMMUNITY. INC. tot '$$ eevrm ria lOtaTe F, TO SAN SIMEON BY THE SOUND NURSING HOME, INC. "` -'' '' rr? ! RwwdN AI IINw*N Awn,..This I.wnn.t+.w.M 1 11.....A.0.4 T«Tw n0ae 00.10 e.TWO no!"O e" RETURN BY MAIL TO. lmn,nn•A 1r / emerloen title Inwrencte cam New northeast region //'qq�0. '-�� {��'J'/ :e N./Ii t., A N.naw M Tb ea+lnmYl hwrwr brrsvnY. ' C w Y k ,1'}"'Y 1.. ' 1. I�I�•:Kms{ SWPJd S , y - N Y t f I I,. .. 1.� SOUTHOLD TOWN PLANOG BOARD 3 JUN*4, 1993 2. The installation of drainage structures to prevent runoff from entering Ackerly Pond Lane. Additional information must be presented in regard to the drainage structures as per the Engineering Inspector' s report dated May 20, 1993 . A performance bond estimate must also be calculated for the cost of the construction. The drainage structures must be installed prior to endorsement of the final map, or a performance bond must be presented. An administration fee of 6% of the total bond estimate amount will also be required prior to endorsement of the subdivision. 3. The Planning Board is awaiting additional information from the Southold fire District in regard to their firewell recommendation. You will be notified under separate cover if the Planning Board determines that a firewell is required. If one is required, the cost of such must also be included in the bond estimate. Mr. Orlowski: Second. Mr. Ward: Motion seconded. All those in favor? Ayes: Mr. Ward, Mr. Latham, Mr. Orlowski, Mr. Edwards, Mr. McDonald. Mr. Ward: Opposed? Motion carried. Mr. Ward: 7: 35 p.m. San Simeon Retirement Community & NursingHome. This proposal is to convey 6.594 acres from a vacant 37. 555 acre parcel to be merged with a 3 .581 acre parcel containing a nursing home. Both parcels are zoned Hamlet Density. SCTM #1000-45-2-p/o 10. 2. Is there anybody here this evening that would like to address the Board regarding this lot line change. If not, does the Board have any questions? Board: No questions. Mr. Ward: What is the pleasure of the Board? Mr. McDonald: Mr. Chairman, I would like to make a motion to close this hearing. Mr. Edwards: Motion seconded. All those in favor? Ayes: Mr. McDonald, Mr. Latham, Mr. Orlowski, Mr. Edwards, Mr. Ward. Mr. Ward: Opposed? Motion carried. Mr. McDonald: Mr. Chairman, I would like to make a further motion. " SOUTHOLD TOWN PLAN7&G BOARD 4 JUN*4, 1993 WHEREAS, the San Simeon Retirement Community, Inc. is the owner of the property known and designated as SCTM #1000-45-2-2 and p,/o lot 10 .3 , located at the northeast corner of Route 25 and Chapel Lane in Greenport; and WHEREAS, this lot line, to be known as proposed lot line change for the San Simeon Retirement Community, Inc. is for a lot line change to subtract 6,594 acres from a 37. 555 acre parcel and add it to a 3. 581 acre parcel; and WHEREAS, the Southold Town Planning Board, pursuant to the State Environmental Quality Review Act, (Article 8) , Part 617, declared itself Lead Agency and issued a negative declaration on May 24, 1993 ; and WHEREAS, a final public hearing was closed on said subdivision application at Town Hall, Southold, New York on June 14, 1993 ; and WHEREAS, all the requirements of the Subdivision Regulations of the Town of Southold have been met; and be it therefore RESOLVED, that the Southold Town Planning Board approve and authorize the Chairman to endorse the final survey dated March 1993 . Mr. Edwards: Second. Mr. Ward: Motion seconded. All those in favor? Ayes: Mr. Edwards, Mr. Ward, Mr. Latham, Mr. McDonald, Mr. Orlowski. Mr. Ward: Opposed? Motion carried. xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx Hearings Held Over From Previous Meetings: Mr. Ward: Hillcrest Estates - Section 2 - This major subdivision is for twenty lots on 22.9 acres located in Orient. SCTM #1000-13-2-8.5. Mr. McDonald: Mr. Chairman, I make a motion that this hearing be held open because at the last minute we received a call from a representative of Hillcrest Estates indicating that they were out of the country and were not able to come and plead their case so I would like to hold it open for one more meeting. Mr. Latham: Did they know it was going to be on the agenda? Were they notified? � 1 LEGAL NOTICE& Notice of Public He COUNTY OF SUFFOLP ss. NOTICE IS HEREBY STATE OF NEW YORK 4 GIVEN that pursuant to See- tion 276 of the Town Law, a Public hearing will be held by the Southold Town Planning Patricia Wood, being duly sworn, says that she is the Board,at the Town Hall,Main Editor, of THE LONG ISLAND TRAVELER-WATCHMAN, Road,Southold,New)cork in a public newspaper printed at Southold, in Suffolk County; said Tbwn on the 14th day of and that the notice of which the annexed is a printed copy, June 1993,on the question of the following: has been ,published in said Long Island Traveler-Watchman 7:30 P.M. Final approval for once each week for . . . . . . . . . . . . . . . . . . . . . . . . . weeks the minor subdivision for le Puritan Farms,at Southold,in successively, commencing on the . . . . . . , . . .�9 the Town of Southold, (, • • . • . • . . • ty of Suffolk, State of New York. Suffolk County Tax day of • • , •, 19 . X4 . ap Number 1000-69-5-7. The property is bordenod on the northeast by land new or formerly of J.C.&A.Cornell; by land now or formerly of C.W. & N.S. Wright; by land now or formerly of E. & A. Sworn to before me this . . . . . . . . . . . . �.ep . . . . . day of Marvin; by Ackerly Pond Lane;on the east by land now or formerly of P.F. & D.J. • • • 19 93 Swenkowski;on the southeast !/ by land now or formerly of Edwin Smith; on the southwest by land now or / ,ry formerly of John Rastegarr. . . . Assoc., on the northwest by Notary Public land now or formerly of Christian Frederick Baiz III. BARBARA A. SCHNEIDER 7:35 P.M.Final approval)for NOTARY PUBLIC, State of Nety York the lot line change for Sari Si- No. 4806846 meon Retirement Community Qualified in Suffolk County and Nursing Home,at Green- Commission Expires */3)/9,Y port,in the Tbwn of Southold, County of Suffolk, State of New York. Suffolk County Tax Map Number 1000-45.2-2 and 10.3. The property is bordered on the north by County Road 48; on the west by Chapel Lane; 1 on the south by land now or formerly of San Simeon w Retirement Community and p the Village of Greenport;and on the east by land now or formerly of John J.Siolas and t Charmer Tsounis. Any person desiring to be heard on the above matter should appear at the time and ` place above specified. nn IA r 1Iof p Dated: June 8, 1993BY ORDER OF THE SOUTHOLD TOWN JUN NPLANNING BOARD t Richard C. Ward, Chairman SOUTHOLD TOAIN IX-6/10/93(40) PLANNING BOARD • COUNTY OF SUFFOLK • 6E- P� a& ROBERT J.GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PLANNING ARTHUR H. KUNZ DIRECTOR OF PLANNING June 10, 1993 Plat Name: San Simeon Retirement Community (Lot Line Change) Richard Ward, Chairman Tax Map No. : 1000-45-2-2 & P/0 10.3 Town of Southold Planning Board SCDP File No. : S-SD-93-05 Main Road Southold, NY 11971 Dear Mr. Ward: Pursuant to the requirements of Section A14-24, Article XIV of the Suffolk County Administrative Code, the above captioned proposed final plat which has been referred to the Suffolk County Planning Commission is considered to be a matter for local determination; however, this shall not be construed that the Commission has either approved or disapproved this particular plat. Very truly yours, Arthur H. Kunz Director of Planning S/s Frank Dowling, Senior Planner Subdivision Review Division FD:bh JUN I 11993 SOUTHOLD TIO1WN PLANNING BOARD H.LEE DENNISON BUILDING ■ VETERANS MEMORIAL HIGHWAY 0 HAUPPAUGE. NEW YORK 11788 111 (516) 8535192 Su6J COUNTY OF SUFFOLK �,� JUN 7 1993 a � SOUTHOLO.0b1'feV. _ 1 PLANNING BOARD ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PLANNING ARTHUR H. KUNZ DIRECTOR OF PLANNING June 3, 1993 Richard Ward, Chairman Town of Southold Planning Board Main Road Southold, NY 11971 Preliminary Final X Plat Name: San Simeon Retirement Community Tax Map #: 1000-45-2-2 & p/o 10.3 SCPD File No. : 1333-INC-93-14 Dear Mr. Ward: Please be advised that pursuant to Section A14-24, Article XIV of the Suffolk County Administrative Code, the above referral will not be reviewed by the Suffolk County Planning Commission because of noncompliance with requirements for notice and maps as stipulated in Informational Bulletin #9 of the Suffolk County Planning Commission. The staff has checked the above referenced referral and find that it is incomplete and that the following items are required: 3 copies of final map with acceptable title and lot numbers. Very truly yours, Arthur H. Kunz Director of Planning S/s Frank Dowling, Sr. Planner Subdivision Review Division FD:mb NOTE: Please consult Suffolk County Department of Planning Informational Bulletin No. 9 for complete referral requirements. H.LEE DENNISON BUILDING 0 VETERANS MEMORIAL HIGHWAY ■ HAUPPAUGE, NEW YORK 11788 111 (516) 853-5192 O 1 y PLANNING BOARD MEMBERS „i SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman. �� Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765=1823 June 10; 1993 Frank Dowling, Senior Planner Suffolk County Department of Planning H. Lee Dennison Building Veterans Memorial Highway Hauppauge, NY 11788 RE: Lot Line Change for San ,Simeon Retirement Community Route 48 & Chapel Lane, Greenport SCTM# 1000-45-2-2 & p/o 10. 3 Dear Mr. Dowling: The Planning Board has received your letter of June 3, 1993, regarding the above referenced project. As discussed with staff member Robert Kassner, attached are maps with the changes requested. The Board would appreciate a letter of "Local Determination” in order to proceed with this application. If you have any questions, or require further assistance, please contact this office. (iili4� , j. Ward Chairman COUNTY OF SUFFOLK KK dill! ? S SOUTHOLD'O7idI PLANNIn10 BW@ t ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PLANNING ARTHUR H. KUNZ OIRECTOR OF PLANNING June 3, 1993 Richard Ward, Chairman Town of Southold Planning Board Main Road Southold, NY 11971 Preliminary Final X Plat Name: San Simeon Retirement Community Tax Map #: 1000-45-2-2 & p/o 10.3 SCPD File No. : 1333-INC-93-14 Dear Mr. Ward: Please be advised that pursuant to Section A14-24, Article XIV of the Suffolk County Administrative Code, the above referral will not be reviewed by the Suffolk County Planning Commission because of noncompliance with requirements for notice and maps as stipulated in Informational Bulletin #9 of the Suffolk County Planning Commission. The staff has checked the above referenced referral and find that it is incomplete and that the following items are required: 3 copies of final map with acceptable title and lot numbers. Very truly yours, Arthur H. Kunz Director of Planning S/s Frank Dowling, Sr. Planner Subdivision Review Division FD:mb NOTE: Please consult Suffolk County Department of Planning Informational Bulletin No. 9 for complete referral requirements. H.LEE DENNISON BUILDING ■ VETERANS MEMORIAL HIGHWAY ■ HAUPPAUGE. NEW YORK 11766 ■ 15161 853-5192 5u er, PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-2954 June 8, 1993 Southold Planning Board Main Road Southold, NY 11971 ATT: Bob Kassner RE: San Simeon Lot Line Change SCTM #45-2-10.3 ""'Vh6 Dear Mr. ssner, Please find attached the three additional copies of the site plan showing the lot line change you requested. If you have any questions regarding this matter, please call me at my office. r uly, Jo e h Fischetti, P.E. 11 ,Ac& LG, • • • ybsr R.e�FY� :::::::::::ADD NEW::::NE GATIVE DEC;LARATION:::::::::::::::::::::::;:::::::::::::::::::::::::::"::iii: ::::::::::::::::::::::::::::::::::::::::::::::05 27 93: 16: 17 .............. ILE NUMBER ;::::N1473800-00867::::::::Town of SOUTHOLD, SUFFOLK County EAD AGENCY: :::::::::!::473800::::::::::!::::::::::::::::::::Town of SOUTHOLD, SUFFOLK County ......................... ............................................................................................................................................................................ FI _ or BO.A....R....D...:.:...!.?.:.:.P.....1..:a....n....n....i......rig ... Board oar...d.... .. . . LAS: :T5:;UT nleist1ed . .ii.ii......... ......: . ::::::i:::e TITLE ::: Lot line Ch e San Simeon : : :::::a.:l::::i . yp .........................................:...........................,.................................. ESCRIPTION : 'iModification of lot lines for San Simeon Retirement Community and ... `Nursing Home on Cor Rt 25 & Chapel .............. ::::: ::::::::::::::::::::::.:::::::............. . ...... ........ ........................................................................................................................... VF ................:......................:::.........._:...,...:....... .::.........:...........,........................................................................................................... .................................................................. .........................j'; rddi : COUNTY OF SUFFOLK R� ✓ p- ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF PUBLIC WORKS STEPNEN G. HAYOUK,P.E. COMMISSIONER May 17, 1993 Town of Southold Planning Board Office 53095 Main Road P.O. Box 1179 Southold, New York 11971 Attention: Richard G. Ward RE: C.R. 48, Middle Road - SAN SIMEON RETIREMENT COMMUNITY i NURSING HOME SCTM #1000-45-2-p/o 10.3 SCTM #1000-45-2-2 Gentlemen: This Department has reviewed the above referenced project. Specifically note that: A permit from this Department will not be required. We have reviewed this development and find that no additional improvements within the County right-of-way in the vicinity of this site will be required. If you have any questions, kindly contact this office at 852-4099. Thank you for your cooperation in this matter. Very truly yours, Richard J. LaValle, P.E. Chief Engineer I-- a�By: M. Paul Campagnola Permits Engineer RJL/MPC/,i fb KAIN a 2 61993THOLD TowNNING BOHP� SUFFOLK COUNTY IS AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER 335 YAPHANK AVENUE n YAPHANK. N.Y. 11980 • (316) 852-4000 FAX (516)852-4150 FF014, o PLANNING BOARD MEMBERS w T SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman Supervisor George Ritchie Latham. Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 May 25,1993 Joseph Fischetti, Jr. Professional Engineer Hobart Rd. Southold, NY 11968 Re: Proposed lot line change for Sq,A i irement Community and Nursing Home Greenport, NY 11944 Dear Mr. Fischetti: The following resolutions were adopted by the Southold Town Planning Board at -a meeting held on Monday, May 24, 1993 : BE IT RESOLVED that the Southold Town Planning Board, acting under the State Environmental Quality Review Act, established itself as lead agency, and as lead agency makes a determination of non-significance and grants a Negative Declaration on this unlisted action. BE IT RESOLVED that the Southold Town Planning Board set Monday, June 14, 1993 at 7: 35 P.M. for a final public hearing on the maps dated March 1993 . Enclosed please find a copy of the Negative Declaration for your records. Sincerely, Richard G. Ward Chairman enc. • ;�'�jL'ffD • 1� PLANNING BOARD MEMBERS vim- ^V7 SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman �'"^"� ,`� Supervisor George Ritchie Latham, Jr. Richard G. Ward - ,may' Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 State Environmental Quality Review NEGATIVE DECLARATION Notice of Determination Non-Significant May 24, 1993 This notice is issued pursuant to Part 617 of the implementing regulations pertaining to Article 8 (State Environmental Quality Review Act) of the Environmental Law. The Southold Town Planning Board, as lead agency, has determined that the proposed action described below will not have a significant effect on the environment and a Draft Environmental Impact Statement will not be prepared. Name of Action: Lot line change for San Simeon Retirement Community & Nursing Home SCTM# : 1000-45-2-p/o lot 10. 2 Location: Northeast corner Rt. 25 and Chapel Lane, Greenport SEAR Status: Type I ( ) Unlisted ( X ) Conditioned Negative Declaration: Yes ( ) No ( X ) Description of Action: This proposal is to convey 6. 594 acres from a vacant 37. 555 acre parcel to be merged with 3 .581 acre parcel containing a nursing home. Both parcels are zoned hamlet density. Page 2 San Simeon lot line change - SEQR Negative Declaration May 24, 1993 Reasons Supporting This Determination: Both lots are in the Hamlet Density District. The existing nursing home is on 155,999 square feet and the parcel to be conveyed is 287,241 square feet, thus the merged parcel will be 1,635, 914 square feet; more than the required 20,000 square foot minimum for this district. The applicant will have to comply with the requirements of the Suffolk County Sanitary Code (SCSC) and all relevant standards of water supply and sewage disposal systems. This impact is not considered significant due to the anticipated project compliance with established requirements of the SCSC and the Suffolk County Department of Health Services (SCDHS) and the required obtainment of the relevant permits. Because there has been no correspondence received from the New York State Department of Environmental Conservation in the allotted time, it is assumed that there are no comments or objections from that agency. For Further Information: Contact Person: Robert G. Kassner Address: Planning Board Telephone Number: (516) 765-1938 cc: Suffolk County Deparment of Health Services Suffolk County Planning Commission Dave Morrell, DEC Commissioner Judith Terry, Town Clerk Building Department Applicant .5a r3FiG.9, COUNTY OF SUFFOLK • ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE DEPARTMENT OF HEALTH SERVICES MARY E. HIBBERD, M.D., M.P.H. COMMISSIONER May 12, 1993 Robert G.Kassner Town of Southold Town Hall-53095 Main Road P.O.Box 1179 Southold,New York 11971 RE: Lot Line change for San Simeon Retirement Community&Nursing Home SCTM#: 1000-45-2-p/o 1.0.3& 1000-45-2-2 Dear Mr.Kassner: The Suffolk County Department of Health Services(SCDHS)has received your letter dated April 12, 1993, concerning the above-referenced application,and has no objection to the Town's designation as lead agency. This correspondence is intended primarily to expedite the procedural requirements of SEQRA pertaining to the establishment of lead agency.The comments provided below are,therefore,general in nature,representing several of our most common concerns regarding Suffolk County projects.The department wishes,however,to reserve its right to provide more detailed information within the comment period(s)established for this action. I. Suffolk County Sanitary Code (SCSC) 1. The SCDHS maintains jurisdiction over the final location of sewage disposal and water supply systems,pursuant to the authority and requirements of Articles 4,5,6 and 7 of the SCSC. Applications must comply with all relevant density and construction standards for water supply and sewage disposal. Applicants should not undertake the construction of,or connection to,either system without Health Department approval. 2. Where applicable,the deportment regulates the storage,handling and discharge of restricted toxic and hazardous materials pursuant to the requirements of Articles 7& 12 of the SCSC. 3. If an application has not yet been submitted to the SCDHS,one should be filed at the earliest date to allow for the technical review of the proposed action.Project designs submitted to the department should be fully consistent with any action currently under review through the SEQRA process. 4. Design and flow specifications,information regarding subsurface soil conditions,water supply information,and complete design details are essential to the review of this project,and are evaluated fully at the time of application review. Should the town require additional environmental information(such as a DEIS),discussion of the compliance requirements of the SCDHS should be required. 5. Of particular concern to the department are those areas which because of elevated groundwater conditions,or soils which are not conducive to the proper functioning of conventional subsurface sanitary sewage disposal systems. Your agency should be aware that such conditions frequently require the use of fill or the excavation of subsurface soils to accommodate subsurface sanitary disposal systems constructed in conformance with p � � [ �drn DIVISION OF ENVIRONMENTAL QUALITY I COUNTY CENTER ' RIVERIiN.Y. 1 1 801-398] MAY �� 852-2100 OD SOUTtIOLD TM) N PLANNING BOAF:O i Letter to Robert G. Kassno May 12, 1993 Page 2 6. The department is also significantly concerned with areas where access to potable water may be constrained by unacceptable groundwater quality and the lack of an available public water supply.All private water supply systems must be constructed in conformance with requirements of the SCSC. H. NATURAL RESOURCES: 1. The SCDHS fully supports all efforts to maximize protection of natural resources which may be impacted upon by construction and development activities.It is the position of the department that the SEQRA review process provides the greatest opportunity for comprehensive consideration of these resources,and that all practicable planning measures should be employed to help ensure their protection. Of particular concern to department is the adequate protection of wetlands,surface waters,natural communities, contiguous natural habitats,and rare,threatened and endangered species.In addition,efforts to protect sensitive physical resources such groundwaters,dunes,bluffs,shorelines,natural drainage channels,groundwater recharge areas,and steep slopes are fully supported and encouraged by the SCDHS. In general,the department encourages the following land use measures be considered(where appropriate)to actions being reviewed pursuant to SEQRA. 1.Maximum practicable setbacks from all wetlands,surface waters,dunes,and bluffs. 2.Non-disturbance buffers between wetland limits and required structural setbacks. 3.Clustering of subdivision lots to provide for maximum preservation of large contiguous areas of dedicated open space. 4. Stringent clearing limitations which can reduce potential impacts to wildlife habitats,vegetative communities,and unconsolidated sods. 5.Maximum practicable confinement of development to areas with slopes of less than 10%. 6.Maximum use of native species for landscaping purposes. 7.Construction of recharge areas,so as to minimize the amount of disturbance and structural modification to the site. 8.Maximum use of land-banked parking on commercial sites. 9.Minimal use of fertilizer-dependant turf and landscaping. 10.Employment of storrnwater runoff control measures necessary to maintain runoff on-site. The department appreciates the opportunity to participate in the SEQRA review of this proposal.Additional information may be provided prior to the close of the established comment period.Should you have any questions or require additional information,please feel free to contact the Office of Ecology at 852-2078. Sincerely, Madr J.Reusclde Environmental Planner Office of Ecology MJR/amf cc: Vito Minei,P.E. Stephen Costa,P.E. • o��S�FFO(�-c • OG$-A co .c 0 PLANNING BOARD MEMBERS 0 SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman ?. ® �� Supervisor George Ritchie Latham. Jr. �47j Richard G. Ward Town Hall, 53095 Main Road P.O. Box 1179 Mark S. McDonald Southold, New Yorkk 11971 Kenneth L. Edwards PLANNING BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 � 7 1993 Suffolk County Planning Commision H. Lee Dennison Executive Office Building- 12th Floor Veterans ,Memorial Highway Hauppauge, New York 11788 Attention: Mr. Frank Dowling, Senior Planner Subdivision Review Division Gentlemen: Pursuant to Section A14-24, Suffolk County Administrative Code, the Southold Town Planning Board hereby refers the following pro sed s v si.o to ,tC�1) Su folk Cou ty Planning Co issio : Aj Mali o"f - Hamlit/Locali S.C.D.P.W. Topo No. : Zoning S.C. Tax Map No. : /COD - /I(, - V, - L 6T_L/N/%clta: Major Sub. _ Minor Sub. Site Plan Cluster MATERIAL SUBMITTED: Preliminary Plat ( 3 copies) V Road Profiles (1) Drainage Plans (1) _Topogroaphical Map (1) Site Plan (1) __ Grading Plan ( 1) Other materials (specify and give number of copies) Waiver of Subdivision Requirements - See attached sheet // CONTINUED .L REFERRAL CRITERIA: SEQRA STATUS- 1. The project is a (Unlisted) (Type I) (Type II)Action. 2. A (Negative Declaration) (Positive Declaration) (Determ. of Non-Significance) has been adopted by the Planning Board. 3 . E.I.S. statement enclosed. (Yes) (NO) . 4. The proposed division has received approval from the S.C. Dept of Health. (Yes) (No) . Comments: /?d; iWGy 571f,ef Q We request acknowledgement of receipt of this referral (Yes) (No) Referral received 19 by Suffolk County Planning Commission and assigned File NO. y ly yours, Richard G. Ward Chairman �SUFF�(k�� RAYMOND L. JACOBS t�T+ rZ JAMES A. RICETER SUPERINTENDENT OF ENGINEEQING El=11 AYS 'r1J+O1 �.aO� INSPECTOR 765-3150 763-3070 OFFICE OF THE ENGINE:R TOWN OF SOUTHOLD M E M O R A N D U M TO: RICHARD G. WARD Chairman -- Planning Board FROM: JAMES A. RICHTER SUBJECT: Short Environmental Form `JON smFoN KE,-nAemcwr (',Dr*mUNtTY DATE: ry _IS- 93 As per /your request, enclosed please find the short environmental assessment: form for the above referenced project. Please be advised that Part III of this form still requires your signature and related information. If you have any questions, please contact my office at your earliest convenience. Enc: i 17 , ! 5 !993 n PLANNING BOARD MEMBERS y. SCOTT L. HARRIS Bennett Orlowski, Jr.. Chairman � tti Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards Southold, New York 11971 PLANNING BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 MEMORANDUM TO: James Richter, Engineering Inspector FROM: Richard G. Ward, Chairman (J�J� RE: Review of Short Environmental Assessment Form for Lot-Line Change for San Simeon Retirement Community & Nursing Home, Route 48 Greenport SCTM# 1000-15-3-1 DATE: April 13, 1993 Please review the attached Short Environmental Form (SEAF) . If you have any questions, please contact Robert Kassner of this office. Enc. cc: Raymond Jacobs, Highway Superintendent • �®gpFFOlkc C= PLANNING BOARD MEMBERS ,r T SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman Hifi ® 0�� Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards Southold, New York 11971 PLANNING BOARD OFFICE Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 April 13, 1993 Joseph Fischetti, Jr. Professional Engineer Hobart Road Southold, NY 11971 RE: Proposed Lot Line Change for San Simeon Retirement Community and Nursing Home, County Road 48 Greenport SCTM# 1000-45-2, P/O lot 10 . 2 Dear Mr. Fischetti: The following resolution was adopted by the Southold Town Planning Board at a meeting held on Monday, April 12, 1993 . BE IT RESOLVED that the Southold Town Planning Board start the lead agency coordination process on this unlisted action. Please do not hesitate to contact this office if you have any questions regarding the above. Sincerely, / iC-CGaA�vv� � L��vC� Richard G! Ward Chairman 11.16-4(2/87)=70x1 12 PROJECT I.D.NUMBER 617.21 SEOR 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) APPLICANT Oyry SOR / 2. PROJECT N E S rwrwt7 a rlr.%A4I6` G�1 KIVYl� Zo .��at 3. PROJECT LOCATION:: 4-- - c /L Municipality crt ec o GM - County so 44`^� / 6 r A. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 5. IS PROPOSED ACTION: ❑New ❑Expansion Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: l,of -e Cti�►+� el 7. AMOUNTOF AF �— Initially acres Ultimately ' acres B. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? %Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential ❑Industrial ❑Commercial ❑Agriculture - ❑Park/Forest/Open space ❑Other escribs: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)?cif ❑Yes ➢CJ No If yes, list agency(s)and permitlapprovais - 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes 1�1 No If yes, list agency name and permitlapproval 12. AS A RESULT O\PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes No 1 CERTIFY THAT THE INFORMATION PROVIDED ABBOVE IS TRUE TO THE BEST OF MY KNOWLEDGE L Applicant/sponsoii==614. Date:Inc PH FISC-Hr;il, JD. Signature: ESS"� the action Is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER - 1 PART II—ENVIRONMENTAL ASST-_--ENT (To be completed by Agency) A. DOES ACTION EXCEED tCEED ANY TYPE I THt,SHOLD IN 6 NYCRR, PART 617.12? If yes,coordina,s the review process and use the FULL EAF. C]Yes Yes No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. ❑Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources; or community or neighborhood character? Explain briefly: C9. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats,or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted,or a change In use or Intensity of use of land or other natural resources?Explain briefly. C5. Growth.subsequent development,or related activities likely to be induced by the proposed action?Explain briefly. C6. Long term, short term,cumulative, or other effects not identified in CI.C5?Explain briefly. C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes ❑No If Yes,explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility;(e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ 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 this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the"reasons supporting this determination: Name of Lead Agency Print or Type Name of Responsible O ficer in Lead Agency Title of Responsible Officer Signature n Responsible O icer m Lead Agency Signature o Preparer D i erent from responsi e o icer) Date 2 '14-16.4(2187)—Text 12 - r PROJECT I.D. NUMBER 617.21 .SEAR 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) S � APPLICANT�,s�Op SOR 2. PROJECT NA�IM+E !►gtwrl l4 i1r4•+s•.v- 1.�1 »aw,i DoT /nt fti�s� 3. PROJECT LOCATION: ���1 Municipality ���� �� County SO 4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map) 5. IS PROPOSED ACTION: ❑New ❑Expansion Modificationlalteration 6. DESCRIBE PROJECT BRIEFLY: 1%6f im-e Gti +� 7. AMOUNT OFjtb�AFg!CTEb: �— Initially acres Ultimately � acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? AYes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICIN TY OF PROJECT? Residential El Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other escribe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)?➢U-�( „ ❑Yes Nc If yes, list agency(s)and permitlapprovals 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ISI No If yes,list agency name and permitlapproval 12. ASA RESULT O`PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Dyes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE , Applicant/spons r e: rS �SC ` e,PF y � Date: s�y� p� SE�it in Signature: SOL'F+n r i �• 1_�.'...y,. if] �_' 71 LR rp' r�E the action is in the Coastal Area, and you are a state agency, complete the'" '! Coastal Assessment Form before proceeding with this aa`sessment OVER PART II—ENVIRONMENTAL ASSESSMENT (To be completed by Agency) A. DOES ACTION GEED ANY TYPE I THE^ OLD IN 6 NYCRR, PART 617.12? If yes, coorcl natq ..a review process and use the FULL EAF. ❑Yes 1Z No 8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No,a negative declaration may be superseded by another involved agency. Yes ❑No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: Mo. C2. Aesthetic,agricultural, archaeological,historic,or other natural or cultural resources; or community or neighborhood character? Explain briefly: N o. C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: MO. Cd. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land or other natural resources?Explain briefly. N0. C5. Growth,subsequent development,or related activities likely to be induced by the proposed action? Explain briefly. YES - POSSibLE, _UPANsi0N of 6XISTINLzI MLJR51l # IDMS FACILd)ES . C6. Long term, short term,cumulative,or other effects not identified in C1.C5? Explain briefly. N D. C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly. No. D. IS THERE, OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ❑Yes �No If Yes, explain briefly PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. ❑ 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. Vf Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental Impacts AND provide on attachments as necessary, the-reasons supporting this determination: - Name o Lead Agency Prat or Type Name or Responvble Officer,n Lead Agency Title of Re Po ,ble Officer SLP A .yA � Signature et Responsible officer in Lead Agency ignature o reparer(I i event from responsible officer) Date 2 PLAni'IVINGI3`O� RD T0 ' Y 01 SOU HOLD St FFOLTY Southold, N.Y. 11971 (516) 765-1933 QUESTIONNAIRE TO BE COMPLETED AND SUBMITTED WITH YOUR APPLICATIONS FORMS TO THE PLANNING BOARD Please, complete, sign and return to the Office of the -Planning Board with your completed applications 'forms. If your answer to any of the following questions is ves , please indicate . these orf your guaranteed survey or submit other appropriate evidence; 1. Are there any wetland grasses on this parcel? Yes No (Attached is a list of the wetland grasses defined by the Town Code, Chapter 97, for your reference) 2. Are there any other premises under your ownership abutting this parcel? Yes No 3. Are there any building permits pending on this parcel? Yes No 4. Are there any other applications pending concerning this property before any other department. ur agency? (Town. ,, State, County, etc. ) Yes No 5. Is there any application pending before any other agency with regard to a different project on this parcel? Yes No 6, Was this property the subject of any prior. application to the Planning Board? Yes No 7, Does this property have a valid certificate of occupancy, if yes please submit a copy of same Yes No I e f,, that thJa ve tatcments arc true and e:ill be. relied on t c Plan innd n considering this appl_Ica" ' on. Sig a ure of property owner or authorized agent date . .. PROFESSIONAL ENGIN;-,Z No6a�t .Roa 1 ' 'Souihoid, N, Y, 11971 Attachment to questionnaire for .the Planning Board STATE OF NEW YORK, COUNTY OF SUFFOLK, ss : On the day of I r� 19 , before me personally came_ —�o o o T kS Gh to me known to be the individual described in and who executed the foregoing instrum and acknowledged that p– executed the s F.e. NotAry Public ELIZABETH ANN NEVILLE Notarryy Public,State of New York No.52-8125850,Suffolk Cgggggg111111yyyyyy������ty Terre Expires October 31,19'x. r/Z o PLANNING BOARD MEMBERS a ba SCOTT L. HARRIS Bennett Orlowski, Jr., Chairman '�> `" O�� Supervisor George Ritchie Latham, Jr. Richard G. Ward Town Hall, 53095 Main Road Mark S. McDonald P.O. Box 1179 Kenneth L. Edwards PLANNING BOARD OFFICE Southold, New York 11971 Telephone (516) 765-1938 TOWN OF SOUTHOLD Fax (516) 765-1823 April 12, 1993 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 which you believe should be evaluated. Enclosed please find a copy of the proposal and a completed Environmental Assessment Form (EAF) to assist you in your response. Project Name: Lot Line Change for San Simeon Retirement Community & Nursing Home SCTM #1000-45-2-p/o 10. 3 SCTM #1000-45-2-2 Requested Action: This proposal is to convey 6. 594 acres from a vacant 37. 555 acre parcel to be merged with 3. 581 acre parcel containing a nursing home. Both parcels are zoned hamlet density. SEQRA Classification: ( ) Type I (x ) Unlisted Contact Person: R. G. Kassner ( 516)-765-1938 The lead agency will determine the need for an environmental impact statement (EIS) 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. µ Planning Board Position: (x ) This agency wishes to assume lead agency status for this action. ( ) This agency has no objection to your agency assuming lead agency status for this action. ( ) Other. ( See comments below) . Comments: Please feel free to contact this office for further information. Sincerely, Richard G. Ward, Chairman cc: *Building Department Southold Town Board *Suffolk County Dept. of Health Services NYSDEC - Albany *S.C. Dept. of Public Works * Maps are enclosed for your review Coordinating agencies S� cE PROFESSIONAL ENGINEER/ HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-2954 April 8, 1993 Southold Planning Board Main Road Southold, NY 11971 RE: San Simeon Lot Line Change SCTM #45-2-10.3 Gentleman, Please find attached the April 5, 1993 letter from the San Simeon Retirement Community, Inc. confirming the merging of the parcel in question upon approval of the lot line change. rseph rP.E., FAPLIR - 819A(; • � SuSP'iC,U RK. PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-2954 April 7, 1993 Southold Planning Board Main Road Southold, NY 11971 RE: San Simeon Lot Line Change SCTM #45-2-10.3 Gentleman, Please find attached eight sets of site plans showing the proposed lot line change. These plans have been revised from prior plans reviewed by you to include, zoning lines, tax map numbers, and adjacent property owners as requested by Bob Kasner. If you have any questions regarding this matter, please call me at my office. Ieph ru y, Fischetti, P.E. APR T KW sNbr-ILE R k co/u- Us PROFESSIONAL ENGINEER HOBART ROAD SOUTHOLD, NEW YORK 11971 516-765-2954 April 5, 1993 Southold Town Planning Board Main Road Southold, New York, 11971 RE: San Simeon Rftirement Community - Lot Line Change SCTM# 045-2-40.3 aKd Gentleman, Please find attached the following for your consideration in approving the lot line change as referenced above. 1. Eight copies of the site plan prepared by the H,M Group (to follow) 2. Questionnaire 3. Fee of $50.00 4. Completed Application 5. Short Form Environmental Assessment 6. Copy of Affidavit and Statement that the properties will marge (signed copy to follow) We would like to be considered to be placed on the Board's agenda for the April 12, 1993 meeting date. If there is any questions concerning this submission, please call. Tsp lly yours, schetti, P.E. PR — F 1993 .� San Simeon Retirement Community •LASER FICHE FORM • SUBDIVISIONS Proiect Type: Lot Line Changes Status: Final Approval SCTM # : 1000 - 45.-2-10.2 Proiect Name: San Simeon Lot Line Change Location: northeast corner of NYS Route 25 and Chapel Lane in Greenport Hamlet: Greenport Applicant Name: San Simeon Retirement Communitv Owner Name: San Simeon Retirement Community Zone 1 : HD Approval Date: 6/14/93 PLAT Signed Date: &b4/q3 OPTIONAL ADDITIONAL INFORMATION A date indicates that we have received the related information Zone 2: LB Zone 3: C and R's : Homeowners Association R and M Agreement: Address: scANNe� County Filing Date: L Recon? . 1an'1.;ement SCAN Date: