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CON1'Ollr.:s AND E'LcVAn ON S FlZOM COlON," -ropo <VI AP.
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CAS'$I'-:::'Y
14 APR I '- u8I..D
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MAYril- 1986
Southold Town uoaril of Appeals
MAIN ROAD - STATE ROAD 2S
SOUTHOLD. L.I.. N.Y. 11971
TELEPHONE 15161 765-1809
ACTION OF THE ZONING BOARD OF APPEALS
Appeal No. 3473
Application Dated February 24, 1986 (Public Hearing April 3, 1986)
"''' -
.v.
Mr. and Mrs.
39-17 222nd
Bayside, NY
Joseph A. Cassidy, Jr.
Street
11361
[Appell?"+- !~)]
At a Meeting of the Zoning Board of Appeals held on May 1, 1986,
the above appeal was considered, and the action indicated below was taken
on your 1 Request for Variance Due to Lack of Access to Property
New York Town Law, Section 280-a
[ Request for Special Exception under the Zoning Ordinance
Article , Section
[Xl Request for Variance to the Zoning Ordinance
Article III, Section 100-31
[l Request for
Application of JOSEPH A. CASSIDY, JR. for a Variance to the Zoning
Ordinance, Article III, Section 100-31, Bulk Schedule, for approval of
58,484 sq. ft. parcel with 135' frontage (lot width). Property identi-
fication: County Tax Map Parcel Nos. 1000-79-05-23.1 and 22.1, located
along the west side of Reydon Drive, Southold, NY.
WHEREAS, a public hearing was held and concluded on April 3, 1986,
in the Matter of the Application of JOSEPH A. CASSIDY, JR. under Appeal
No. 3473; and
WHEREAS, the board has considered all testimony and documentation
entered into the record concerning this application; and it is noted
for the record that no public opposition has been received; and
WHEREAS, the board members_have personally viewed and are familiar
with the premises in question, as well as the surrounding area in this
Residential and Agricultural Zoning District; and
WHEREAS, the board made the following findings of fact:
1. The property in question has a frontage (lot width) of 135
feet along the west side of Reydon Drive, Southold, and is identified
on the Suffolk County Tax Maps as District 1000, Section 79, Block 05,
Lot 23.1. .
2. The premises to which this parcel is contiguous to and is
requested to be set-off from is situate to the north, also with a
frontage (lot width) of 135 feet along the west side of Reydon Drive,
with an area of 55,831 sq. ft. (1.27 acres), and is identified on the
Suffolk County Tax Maps as District 1000, Section 79, Block 05, Lot 22.1.
3. The subject parcel is vacant and contains an area of 58,484
sq. ft.; the northerly parcel is improved with a single-family
dwelling built pursuant to Building Permit #11485Z issued 12/7/81.
For the record, the subject parcel was conveyed from Akscin to
(CONTINUED ON PAGE TWO)
DATED: May 8;-1986.
~ Form ZB4 (rev. 12/81)
",ok 5lCf \~
CHAIRMAN, SOUTH OLD TOWN ZONING BOARD
OF APPEALS
Page 2 - Appeal No. 3473
Matter of JOSEPH A. CASSIDY, JR.
Decision Rendered May 1, 1986
Cassidy 12/29/83, and the Cassidys
Department approval of construction
.11/16/~1. The. northerly p~rce1 was
9/8/81.
obtained Suffolk County Health
under Permit #11-S0-124 on
conveyed from Akscin to Rich
I
4. It is the opinion of the board that a majority of the lots
in the immediate area are of a size 40,000 sq. ft. or more, similar
to the parcel in question; and that denial of the variance would
impose significant economic injury since there is no other method
feasible for appellant to pursue other than a variance.
In considering this appeal, the board finds and determines:
(a) that the relief requested is the minimum necessary; (b)
that the character of this residential nei9hborhood would not be
adversely affected by the granting of this variance; (c) that
the property owner will suffer significant economic injury since
there is no other method for appellant to pursue other than a
variance; (d) that the public health, welfare, safety, comfort,
convenience and order of the town will be served by allowing the
variance under the circumstances; (e) the circumstances are
unique; (f) by the granting of this variance, the spirit of
the zoning ordinance and the interests of justice will be served
by granting the variance, as conditionally noted below.
Accordingly, on motion by Mr. Sawicki, seconded by
Mr. Grigonis, it was
RESOLVED, that the variance for approval of insufficient
area of 58,484 sq. ft. and 135' lot width of this parcel as
applied under Appeal No. 3473, JOSEPH A. CASSIDY, JR., BE AND
HEREBY IS GRANTED SUBJECT TO THE FOLLOWING CONDITIONS:
1. Bulk Schedule "A-40" setback regulations shall apply to
thi s parcel;
2. No reduction of front or side yards shall be permitted
for new dwelling to less than that provided by "A-40."
3. Proposed future accessory buildings must be located in
the rearyard area as provided by Section 100-32.
4. No further lot area reductions shall be permitted for
thi s parcel.
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
Doyen, Douglass and Sawicki. This resolution was adopted by
unanimous vote of all the members.
*
*
*
1 k
GERARD
May 8,
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Southold. N.Y. 11971
(516) 765-1938
April 16, 1986
Joseph and Agnes Cassidy
39-17 222 Street
Bayside, NY 11361
RE: Set-off for
Joseph and Agnes Cassidy
Dear Mr. and Mrs. Cassidy:
The following action was taken by the Southold Town Planning
Board, Monday, April 14, 1986.
RESOLVED that the Southold Town Planning Board refer the
following comment with regard to the proposal for Joseph and
Agnes Cassidy to the Board of Appeals:
1. The proposed lots do not conform to the current two-
acre zoning.
If you have any questions, pleas~ don't hesitate to contact
our office.
Very truly yours,
~ QY'loL04,llA. J (fv-~It/).-
BENNETT ORLOWSKI, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Diane M.Schultze, Secretary
cc: Board of Appeals
Southold, N.Y. 11971
(516) 765-1938
May 22, 1986
Mr. and Mrs. Joseph Cassidy
39-17 222 Street
Bayside NY 11361
Re: Set-off for Joseph and Agnes Cassidy
Dear Mr. and Mrs. Cassidy:
The following action was taken by the Southold Town
Planning Board, Monday, May 19, 1986.
RESOLVED that the Southold Town Planning Board approve
the set-off for Joseph and Agnes Cassidy to set off 58,484
square feet from 2.624 acres located at Reydon Drive, Southold,
survey dated as amended February 11, 1986 subject to:
1. Health Department approval of the water and
sewer pursuant to Article 6.
Upon receipt of this approval, the Chairman will endorse
the surveys.
Please contact this office if you have any questions.
Very truly yours,
~rt(U..;tt Orr...ow~/u., QvaMv.v
BENNETT ORLOWSKI, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Diane M. Schultze, Secretary
It
Southold, N.Y. 11971
(516) 765-1938
March 26, 1986
Joseph and Agnes Cassidy
39-17 222 Street
Bayside, NY 11361
Re: Set-off for
Joseph and Agnes Cassidy
Dear Mr. and Mrs. Cassidy:
The Southold Town Planning Board reviewed the above mentioned
file at the Monday, March 24, 1986 meeting.
It was the consensus of the Board to conduct a field inspection
of the premises prior to any further recommendations or action.
If you have any questions, please don't hesitate to contact
our office.
Very truly yours,
~~it OrfftvJ{)J.)fYo~
BENNETT ORLOWSKI, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Diane M.Schultze, Secretary
cc: Board of Appeals
-~.
.
-
fEB 24 1986
Joseph A. Cassidy, Jr.
Agnes P. Cassidy
39-17 222 Street
Bayside, N. Y. 11361
Southold Planning Board
Town Hall
Southold, N, Y. 11971
~a .211 11ft
Re:
Minor subdivision application
375 Reydon Drive, Bayview
Gentlemen:
We are the owners of the property covered by the attached app-
lication for a minor subdivision which we request the Board consider
as a set-off.
The county tax map numbers for the subject property are 1000-
079-05-23.1.
Adjoining property owners
Gaudenzio Soccolich
401 E. Brinkerhoff Ave.
Palisades Park, N.:r. 07650
are as follows:
James H. Rich III
Reydon Drive
Southold, N. Y. 11971
Roy H. Newhouse & WF
Box 1004
Southold, N. Y. 11971
George & Constance Brudermann
525 Lake Drive
Southold, N. Y. 11971
Enclosed is a photocopy of our deed containing the legal description
of the property together with check for $50 covering the filing fee.
/'lours truly,
y~ a. ~4.~L~ Ir'
~P{}4<f
,.Y.S.
i'ransfer
L'ax
,100.00
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etif[-.:-h-
'4~,-~;"....... JO'!::
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TAX MAP
DESIGNATION
D"l. 1000
S.c. 079.00
B1k. 05.00
LotAA,
023.000
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Sundud-N. Y.B. T.V. ~o;'m 8~07. 8-,.8 -~O.(8~in ~nd S~le Deed. with Covenam against GI~rltOr'5 ACU.'idU.11 Of CorpoHtiOl
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONJ,Y.
22031
: "-~. 250'1 tA!i309
THIS INDENnJRE, made the 29th day of December ,nineteen hundred and eighty-three
BETWEEN GEORGE B. AKSCIN and OPAL R. AKSCIN, his wife, residing at
(no #) Wells Avenue, Southold, New York
party of the first part, and JOSEPH A. CASSIDY, JR. and AGNES P. CASSIDY,
his wife, residing at 39-17 222nd Street, Bayside, New York
22031
$..I~~P!.
REAL ESTATE
FES 0 6 1984
TRANSFFR TAX
S{lFF'" l<
I!NTY
~---.--.~ --
.
party of the second part, .
WITNESSETii, that the party of the first part, in consideration of Ten a
______________________ ($10.00) ------------------------------- dollars,
lawful money of the United States, and other valuable consideration
paid
by the party of the second part, does hereby grant and release unto the party of the second part, the heirs or
successors and assigns of the party of the second part. forever,
ALL that certain plot, piece or parcel of land, with the buildings and improvements thereon erected, situate,
lying and being:mclbf at Bayview, near Southold in the Town of Southold,
County of Suffolk, State of New York, known and designated on the
Tax map of said County of Suffolk as District 1000, Section 079,
Block 5, Lot 23, more particularly bounded and described as follows:
BEGINNING at a point on the westerly side of Reydon Drive
distant 300.0 feet northerly from the corner formed by the
intersection of the westerly side of Reydon Drive with the northerly
side of N. Bayview Road; running thence North 720 01' 10" West
408.28 feet; thence North 200 11' 20" East, 150.49 feet; thence
South 690 50' 20" East 411.82 feet to the westerly side of Reydon
Drive; thence South 210 49' 30" West along the westerly side of
Reydon Drive, 135.0 feet to the point or place of BEGINNING.
TOGETHER with all the right, title and interest of the parties
of the first part of, in and to that portion of Reydon Drive adjacent
to said premises to the centre line thereof, subject to public use.
TOGETHER with any right, if any, that the parties of the first
part may be entitled to convey to the parties of the second part, as
follows:
(1) To use for boating, bathing, and fishing, all that portion
of Beach lying in front of Sections A and B, as shown on said Map,
in common with the parties of the first part and with others who now
have or hereafter may acquire rights in the same, subject, however,
to such reasonable rules and regulations with respect to the use
thereof, as the sellers may from time to time put into effect.
(2) The right of way of the roads, highways, streets or lanes
shown on said Map and over a road or highway known as Reydon Drive.
(3) To the reasonable use and enjoyment of that portion of the
inland Harbor owned by Reydon Shores, Inc., and to the use of a
portion of the northerly line of the bulkhead and to such other
portions of said bulkhead as may be set aside in common with the
otner plot owners of plots of Reydon Shores, Inc. to date and others
who may hereafter acquire title to land from Reydon Shores, Inc.,
subject to such reasonable rules and regulations as Reydon Shores,
1.
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Inc. may from time to time put into effect, it being expressly
understood that the seller shall not be liable in any way
whatsoever for any accident or accidents that may occur in
connection with the use and enjoyment of said bulkhead and
harbor from any cause whatsoever.
BEING AND INTENDED TO BE the same premises as conveyed to
the party of the first part by deed dated December 3, 1962 and
recorded in the Suffolk County Clerk's Office on December 3,
1962 in Liber 5273 Page 274.
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TOGETHER with all right, title and interest, if any, of the party of the first part in and to any streets ""d
roads abutting the above described premises to the center lines thereof,
TOGETHER with the appurtenances and all the estate and rights of the party of the first part in and to
said premises,
TO HAVE AND TO HOLD the premises herein granted unto the party of the second part, the heirs or
successors and assigns of the party of the second part forever.
?
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,
AND the party of the first part covenants that the party of the first part has not done or suffered anything
whereby the said premises have been incumbered in any way whatever, except as aforesaid.
AND the party of the first part, in compliance with Section 13 of the Lien Law,covenants that the party of
the first part will receive the consideration for this conveyance and will hold the right to receive su<:h consid-
eration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply
the same first to the payment of the cost of the improvement before using any part of the total of the same for
any other purpose.
The word "party" shall be construed as if it read "parties" whenever the sense of this indenture so requires.
IN WlTNESS WHEREOF, the party of the first part has duly executed this deed the day and year first above
written.
IN PRESENCE OF:
~~~- ~
~ ~eorge B.
cti,; C<d
Akscin -
o l'rJ. {J
Opal R.
Qfi<~..'-
ksc~n
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~:u :1507 tASf312
STAft 01' NIW YOB. COUIITY Of SUFFOLK
..: STAft 011 NIW TolIi COUIITY 01'
...
On tbe29th day of December 19 83, before me On the day of
penoaally came GEORGE B. AKSCIN and persooaDy came
OPAL R. AKSCIN
to me known to be the individual s described in and who
executed the foregoing instnDnent, and acknowledged that
they executed the same.
@~~vw. U-~
Notary Public
BARBARA DIACilUN
Notary Public, State of New YorK
No. 52.4635190 Suffolk County
~m!!ll~~Qn <:xpire~ March 30, 19'?'/
STATI O. NIW TOIIl. 'OUIITY O.
On the day of 19 , before me
personally came
to me known, who, being by me duly ~worn, did depose and
say that he resides at No.
that he is the
of
, the corporation described
in and which executed the foregoing instrument; that he
knows the seal of said corporation; that the seal affixed
to said instrument i~ such corporate seal; that it was SO
affIXed by order of the board of directors of said corpora-
tion, and that he signed h name thereto by like order.
~argain anb 6ale ;Deeb
WITH COVENANT AGAINST GRANTOR'S ACTS
TIn B No.
GEORGE B. AKSCIN and OPAL R.
AKSCIN, his wife
TO
JOSEPH A. CASSIDY, JR. and
AGNES P. CASSIDY, his wife
STANDARD FORM OF NEW YORK lOAaD Of 1tTLE UNDERWIUTERS
DinribouJ by
.. TITlE GUARANTeE-
NEWYORK
A nCOR COMPANY
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, before me
to me known to be the individual described in and who
executed the foregoing instrument, and acknowledged that
executed the same.
..: STATE OF NEW YO.K, COUNTY OF
.s:
On the day of 19 , before me
per~onally came
the subscribing witness to the foregoing instrument, with
whom I am personally acquainted, who, being by me duly
sworn, did depose and say that he resides at No.
that he knows
to be the individual
described in and who executed the foregoing instrument;
that he, said subscribing witness, was present and saw
execute the same; and that he, said witness,
at the same time subscribed h naine as witness thereto.
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1000
07"1,.,0
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SECTION
BLOCK
0$".00
LOT 6).3.<>00
COUNTY OR TOWN
TAX BILLING ADDRESS
Recorded At Request of The Title Guarantee Company
RETURN BY MAIL TO:
Mr. & Mrs. Joseph A. Cassidy, Jr.
39-17 222nd Street
Bayside, New York 11361
Zip No.
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Southold Town Planning Board
Town Hall
Southold, New York 11971
Re: 375" ;!€Ybo!lJ )/fIYt, So()nloJ.b
-r//x /Jjl/P /Ot'() -07'1- tJ,S""- .1.3./
Gentlemen:
The fOllowing statements are offered for your consideration
in the review of the above-mentioned minor subdivision and its
referral to 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 made in
the grades of the existing roads.
(3) No new drainage structures or alteration of existing
structures are proposed.
Yours truly,
(()~a.~c;
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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 plat in
accordance with Article 16 of the Town Law and the Rules and Regulations 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 ,1J$.'.. /{f. P9.4/... P./eU/t:......................
...............................................................................................
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:
Liber .... tj.5':~ '1............ Page .J!!(/................ On f(81?1/IU?Y..~{/1.N;
Liber ........................ Page
On
........................
Liber ........................ Page
On
.......................,
Liber ........................ Page
On
. . . . . . . . . . . . . . . . . . . . . . . ,
Liber ........................ Page
On
........................
as devised under the Last \ViII and Testament of .......................................
or as distributee ........................................................................
..............................................
S. The area of the land is .../,,3. 4. . . . . . . . .
acres.
6. All taxes which are liens on the land at the date hereof have been paid except .IJJ.{)/Y.~-:...
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7. The land is encumbered by '" tl/.o.-1J..e-~................................................
mortgage (s) as follows:
(a) Mortgage recorded in Liber .............. Page.................. in original amount
of $. . . . . . . . . . . . .. unpaid amount $ .....
. . . .. held by ......................
. . . . . . . . . . . . .. address ..................
(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 arc no other encumbrances or liens against the land except ./Up.IV.e:.............
9. The land lies in the following :zoning use districts I) ~ -f.({.?~/).I(,4/.r:!1J.J,.,7. !1(!ir(~ c't/I..T(.Ik}lL
10. No part of the land lies under water whether tide water, stream, pond water or otherwise, ex.
17/'/'tfOX ImI1IEI.'! 6,poo 56/. F7. 19 r /f.r:n-fl ttJHc~~
cept .. .~tJ.~N.69..I,.J.. ..r.t?'<:./ll $... .If. . . f'P.&?:J.. .. !,A,J.r.t;-.tf/J1l.7:'.r.IiPT hy.... . .. .
11. The applicant shall at his expense install all required public improvements.
12. The land ~ (does not) lie in a Water District or Water Supply District. Name of Dis-
triet, if within a District, is ..............................................................
13. Water mains will be laid by .'77'.........................................................
and (a) (no) charge will be made for instalIing said mains.
14. Electric lines and standards wiII be installed by
lines.
and (a)
(no) charge will be made for ins taIling said
15. Gas mains will be instalIed by ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 "E" 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 South old Highway system, annex Schedule "e" 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 \\' hich 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 (lifer proof of title as required by Sec.
335 of the Real Property Law.
21. Submit a copy of proposed deed for lots showing all rC'strictiotls, covenants, etc. Annex
Schedule "D".
.
.
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22. The applicant estimates that the cost of grading and required public improvements will be
$. . .::-.. ... as itemized in Schedule HE" hereto annexed and requests that the maturity of the
Performance Bond be fixed at ... :-:-:. . . . . . .. years. The Performance Bond will be written by
a licensed surety company unless otherwise shown on Schedule "F".
DATE ()~..~./......, 19.ft
.JQS.~;JI!... il.:. .e.IJ.$.~!~ 1- ,. ,)/?:.........
(Nnf Applicant) C1_
By v~.. 4.:. (?~. ~.~ .:. /,. . .r/
(Signatu~~ '~~lJii;ie) ~~
39-11 .z:a.;)1
. .1319.Y~!t>.{.{,..(\Ij... //.:J.~/.................
(Address) -
STATE OF NEW YORK, COUNTY OF . .~.'::".'..:. :'...................., ss:
On the..... }/.~.... day of.... E.~.........., 19.8:~.., before me personally came
. . . ..:r:~ ~ ~P.f!. . It:. S .~.s:-\' ! p. y...'[ ~. . . . . .. to me known to be the individual described in and who
executed the foregoing instrument, and acknowledged that . .!I.~...... executed the same.
STATE OF NEW YORK, COUNTY OF ............................ S5:
V/~~I4M.TMOMN/>. f, ,~'~n~ Y-k
Notary Public NotaryPu~lic. State 0 ew .)1
No. 41_B4S3010
Qualified in Queens coun~
b<m '"'~U~ """"'" ~. 19(1"1.t
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 ..........
~.......................................................................
the corporation described in and which executed t he 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
14-1&4 (9f84)
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PROJECT 1.0. NUMBER
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DIVISION OF REGULATORY AFFAIRS
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I ProJect Information (To be completed by Applicant or Project sponsor)
,. ^'j~S~o")Jl-I It. ell$S/bV. J,f. 2.,y1eSNa,fE VDON D;flt t: SET':'l1rf-'
3. Project location:
Municipality -ro p) A) of SO VIr/f);'/:) County SUrrOI.K
.. Is proposed action:
o New o Expansion UJ Modificationfalteration
5. Describe project briefly: of 1.07 III /lIe 1-/ ItJI1S ()AJ orF 1(; 1111. J. Y SU8-l;>JVlbElJ
SEI oFF fll1 J:I
l3y DEE D l.3y FtJ/?/11Cr(' o /.(JA) Elf ~,fIO ;e TtJ 1?77.
6. Precise location (road intersections, prominent landmarks, etc_ or provide map)
37.5" /?t:: Y bON j) If no'/:- I1T <3;:;yvnavl 5,pv TII,;. 1>
7 _ Amount of land affected:
Initially /.34 acres Ultimately acres
8. Will proposed action comply with existing zoning or other existing land use restrictionsl
IiiI Ye, o No If No, describe briefly
9. What is present land use in vicinity of project?
IKI Residential D Industrial 0 Commercial o Agriculture D Parklandfopen space o Oth" -
..
Describe;
.,.
10. Does action involve a permit/approval, or funding, now or ultimately, from any other governmental agency (Federal, state or localll
DYe, ~NO If yes, list agency(s) and permit/approvals
11. Does any aspect of the action have a currently valid permit or approvall
DYes fXJ No If yes, list agency name and permit/approval type
12. As result of proposed action will existing permit/approval require modificationl
DYe, jgj No .
I CERTIFY THAT THE INFORMA TlON PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
APPIi""l/'PO";?):e Jo s ~ (111 IJ. (!/JS'SID \ Jtf. Date: o1-:u-i'1...
((;.A~-A;.J, (1-
Sigoatu,., K". -' ~....1 a.
1 II A /I
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
. .
PART II Environmental Assessment (To be completed by Agency)
~. .
A. Does action exceed any Type I threshold in 6 NYCRR. Part 617.12l
o Ve, 0 No
If yes, coordinate the review process and use the FULl/LONG FORM EAF.
B. Will action receive coordinated review as provided for Unlisted Actions in 6 NYCRR, Part 617.71
involved action.
o Ve, 0 No
It No. a negative declaration may be superceded by another
C. Could action result in ANY adverse effects on, to, or arising from the following: (Answers may be handwritten, if legible)
Cl. bistins air quality, surface 01 sroundwater quality or quantity, noise levels. eXisting traffic patterns, solid waste production Of disposal, potential for erosion.
drainage or flood ins problems? Explain briefly:
C2. Historic. archeological, visual or aesthetic. or other natural or cultural resources; agricultural districts; or community or neighborhood character? Explain briefl,
C3. Vegetation or fauna, movement of fish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
C4. ^ community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resourcesl Explain briefly.
CS. Growth, subsequent development, or related activities likely to be induced by the proposed actionl Explain briefly.
C6. Secondary, cumulative, or other effects not identified in C1-C6l Explain briefly.
".
C7. ^ change in use of either quantity or type of energyl 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. Ens~.Jre that explanations contain sufficient detail to show that all relevant adverse impacts have been identified
and adequately addressed.
o Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then
proceed directly to the FULL/LONG FORM EAF and/or prepare a positive declaration.
o Check this box if you have determined, based on the information and analysis above and any supporting documentation,
that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide here, and on
attachments as necessary, the reasons supportng this determination:
Agency Name
^,ency Preparer's Name
Preparer's 5ignaturerritle
Date