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HomeMy WebLinkAbout1000-113.-7-19.7 (2) TOWN CLERK TOWN OF ~OUTHOLD Suffolk County. New York 516- 765-1801 N.0 .16 9 0 5' so.t o a, s. Y. ? ~~u~th~' ~Tow. Clerk LOT-LINE CHANGE The following items are to be submitted on the survey for a lot-line change: ) Key Map · ) Lot, block, and section number from tax map, scale and north arrow , /) Name and address of the owner of record Name and address of the person preparing the map (certified engineer, land surveyor, architect, etc.) Property descriptions, dimensions, bearings, square footage , the property being changed and property where additional square footage is coming from. Existing zoning Areas subject to flooding Existing buildings and site improvements, (ie fences, hedges) Indicate the existing lot line (dotted line) with the bearinr and distance and the proposed lot line (solid line) with the new bearing and distance. Location and name of existing streets or right-of-way adjacent to the property. Existing spot grades The following information is to be submitted with the application for a lot-line change: Written and signed letter, notorized, by owners of properties in question approving of the change and reasons for the chang Proposed covenants and restrictions indicating that upon Planning Board approval, the property will be merged. Any existing covenants applying to the property. Form letter regarding drainage, roads, and grading, see attac] Short Environmental Assessment Form, Part I, see attached Application, three pages, last page notorized , see attached PLANNING BOARD MEMBERS BENNETT ORLOWSKI, JR. Chairman ~fILLIAM J. CREMERS KENNETH L. EDWARDS GEORGE RITCHIE LATHA1VI, JR. RICHARD CAGGIANO Town Hall, 53095 State Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1938 Fax (631) 765-3136 PLANNING BOARD OFFICE TOWN OF SOUTHOLD luly 20, 2001 William Chudiak Bergen Avenue Mattimck, NY 11952 RE: Conditional approval for lot line change for Chudiak / Wells SCTM# 1000-113-7-19.7, (15-18) Dear Mr. Chudiak, On December 16, 1985, the Planning Board conditionally approved your Lot Line Change. We have not been informed that the conditions have been met. Please let us know the status of this project. If you have any questions, or require additional information~ please contact this office. Site Plan Reviewer WILLIAM WICKHAM ERIC d. BRESSLER ABiGAILA. WICKHAM LYNNEM. gORDON LAW OFFICES WICKHAM, WICKhAM & BRESSLER, p.c. ~03~5 MaiN rOAD, P.O. bOX 14~4 MaTTITUCK, LoNg iSLAND NEW YORK I195E~ 631-~98-8353 TELEFAX NO. 631-~98-8565 MELVILLE OFfiCE 275 BROAD HOLLOW ROAD SUITE I1~ MELVILLE, NEW YORK H747 August 20, 2001 Michael Verity, Senior Building Inspector Southold Town Building Department 53095 Main Road P.O. Box 1179 Southold, New York 11971 Re: Theodore and Rita Wells SCTM# 113-7-19.19 1575 Cox Neck Road, Mattituck, New York 11952 Southold Town Planning Board Dear Michael: We are the attorneys for Theodore Wells and Rita Wells, who own the above property. We understand that the Town has received inquiries as to the development of tax lot 19.11 for a single family residence. The Wells have a deeded fight of way over the 50 foot right of way outlined in blue. The Wells and their neighbors keep open and use the fight of way on a constant basis for its full extent. Tax lot 19.11 was supposed to have been added to tax lots 15 & 16 per Planning Board lot line change approvals on December 16, 1985 (Chudiak to Zabicky and Chudiak to Becker). At that same meeting, mergers for Chudiak to Wells and Chudiak to Wanat were also approved, and those transfers were made (now tax lots 19.18 and 19.19). The Planning Board approvals prohibited construction of a residence on 19.11 since it was to be added to the two lots which already contained residences. Moreover, the property is an R-80 zone. Please keep us advised if this matter progresses. Very truly yours, . . Abigail A. Wickham AA W/al cc: Valerie Scopaz, SouthoM Town Planning Board Greg Yakabosla', Town Attorney Mr. and Mrs. Theodore Wells 30~Verity ~® 2.5 2.6 7.7 19.28 ' LILCO PLANNING BOARD MEMBE~ · BI~NNETT ORLOWSKI, JR. Chairman WILLIAM J. CREMERS KENNETH L. EDWARDS GEORGE RITCHIE LATI-L~VI, JR. RICHARD CAGGIANO PLANNING BOARD OFFICE TOWN OF SOUTHOLD Town Hall, 53095 State Route 25 P.O. Box 1179 Southold, New York 11971-0959 Fax (631) 765-3136 Telephone (631) 765-1938 Memorandum to the File Date: August 13, 2001 Re: Chudiak Property located in Mattituck on West side of Cox Neck Road, Mattituck, NY SCTM # 1000-113-7-19.11, formerly part of 113-7-12. From: Valerie Scopaz, AICP, Town Planne~,,j. · This memorandum was written in response to a query regarding the status of the Subject lot, noted above. The question before the Town was whether said lot was a recognized building lot. This memorandum presents the history of the parcel as ascertained from the Planning Board's records. In 1984, William Chudiak, through his attorney, Emil De Petris, applied to the Planning Board to set-off two separate building lots from his farm. The set-off of concern to us in this instance is the 80,000 square foot lot that was to be accessed by way of a 50' private right of way from Cox Neck Road. This lot was subsequently acquired by Mr. and Mrs. Kevin Milowski. The lot did not have road frontage on a public street, thus was required to obtain a variance from Section 280A of Town Law for access. On June 13, 1984, the ZBA granted access subject to four conditions, one of which stated that ~Any future subdivision or set-off past this parcel along this or any other right of way will require re-application and consideration by this board for appropriate 280A access consideration (or the Planning Board if same falls within their purview): (A copy of the ZBA decision is attached.) Subsequently, in October of 1985, Mr. Chudiak, again through his attorney Emil DePetris, submitted four separate lot line applications to effect a merging of land between the aforementioned right-of-way and existing lots facing Cox Neck Road, of which there were four: Wanat, Wells, Becker, and Zabicky, (later known as Siderakis). On December 16, 1985, the Planning Board voted to approve the lot line amendments between Chudiak and each of the aforesaid property owners. It appears that some of the neighboring property owners were not prepared or in the position to acquire the additional property at the time of the lot-line applications. The Planning Board approval was subject to conditions that the property of Chudiak be, in each case "conveyed to and merged with the contiguous house lot to the East, ...... and that only one (1) residence together with accessory structures may be constructed and maintained upon the two parcels which will become merged into one....and that the above covenants and restrictions be included in the deed and on the survey map for the lot line change" The approval letter went on to note that the Chairman of the Planning Board would endorse the approval upon receipt of the final surveys as required. (A copy of the approval letters is attached.) A hand-written note in one of the files indicates that Mr. De Petris stated that all lots will be sold, and that Zabicky was not prepared to buy, but that Neudack could buy her parcel. The note goes on to state "they are agreeable to C&Rs that the conveyed property will merge and not have any residences." Further, there is a letter in one of the files dated April 13, 1988, addressed to the Planning Board from Nicholas Kordas, attorney for Lambros and Matrona Siderakis, who had acquired the Zabicky property in 1982. The letter states that the Siderakis' are aware of the terms of the lot-line amendment and are "ready and willing to acquire the vacant land adjacent to their premises". The attorney also sent a letter to Mr. Chudiak expressing his clients' readiness to proceed. A copy of those letters are attached as well. I discussed this matter with the Planning Board at its work session of Monday, August 6th. Two of the members present were on the Board during 1985, and they emphasized that the intent of the lot line applications was to merge land to expand the size of existing lots: not to create new building lots. The record indicates that the subject lot of this memo, 19.11, was intended to be merged with two adjoining lots, and not to be retained for sale as a building lot at some future date. Cc: Planning Board Building Department Town Attorney's Office Southold Town Board of Appeals MAIN ROAD-STATE: ROAD 25 BOUTNOLD, L.I,, N,Y. 11~J?1 TELEPHONE (516) 765-1809 ACTION OF TR~ ZONING BOARD OF APPEALS Appeal No. 3243 Application 9ated April Il, ]984 (Public Hearing Hay ]7, ]984) TO: Mr. and Mrs. Kevin Mi]0wski [Appellant(s)] P.0. Box 134 Cutch0gue, NY ]]935, At a Meeting of the Zoning Board of Appeals held on May 3], ]984, the above appeal was considered, and the action indicated below was on your taken tX] 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 [ ] Request for Variance to the Zoning Ordinance Article , Section [ ] Request for Upon application of KEVIN AND LESLEY MILOWSKI, Box 134, Cutchogue, for a Variance to New York Town Law, Article 16, section 280A, for approval of access over a private right-of-way at the west side of Cox Neck Road, Mattituck, (now or formerly of W. Chudlak); County Tax Map Parcel No. lO00-113-7-part of Lot 12. NY The board made the following findings and determination: By this application, appellants seek approval of access over a 50-foot private right-of-way located at the west side of Cox Neck Road and ex- tending westerly 312.16 feet to the premises in question, which is an 80,000 sq. ft. vacant parcel set off by the Planning Board, File #368, at its Meeting of March 12, 1984. Although the right-of-way has been traveled by farm vehicles, the right-of-way is in need of improvements for satisfactory access by emergency and other vehicles. It is the understanding of the board that this request is for access only to the parcel in question, and it should be understood that any further subdivision or additional dwelling structures wl]] be required to return for an updated review and updated improvements as this board would deem necessary under the circumstances. In considering this appe,al, the board also determines: (a) that the relief requested is not substanti'~l; (b) that'by granting the requested relief, the character of the neighborhood will not be adversely affected; (c) th&t by allowing the variance, no substantial detriment to adjoining praperties would be created; (d) that no adverse effects will be'produced on available governmental facilities of any increased population; ~e) that the relief requested will be in harmony with and promote the general purposes of zoning; and (f) that the interests of justice will be served by allowing the variance, as indicated below. Accordingly, on motion by Mr. Goehringer, seconded by Mr. Doug- lass, it was (CONTINUED ON PAGE TWO) DATED: l june 13, 1984. Form ZB4 (rev. 12/81) CHAIRMAN, SOUTHOLD TOWN ZONING BOARD OF APPEALS Pa~)e.2- APpeal Ho. 3243 ' lqatter of KEVIN AND LESLEY MILOWSKI Decision R~ndered May 31, 1984 RESOLVED, that Appeal No. 3243, application of KEVIN AND LESLEY MILOWSKI for approval of access, BE AND HEREBY IS APeD AND SUBJECT TO'THE FOLLOWING*CONDITIONS: 1. That the right-of-way must be improved a full ten-foot width with four inches of bankrun (mixed with 20% stone content) to the parcel in'question fOr a length of approximately 312.16 feet; 2. Any future.subdivision or set-~off past thl~ parcel along this or any other right-of-way will require re-application an~ . consideration by this board for appropriate 280A access consideration (or the Planning Board if same falls within their PurView}; 3.' The right-of-way must be continuously maintained in good. ".S.~tisfactory condition for access by emergency and other vehicles; 4. Upon written notice to the Building Inspector or Board of Appeals, an inspection and approval of improvements must be made prior to the issuance of a Certificate of Occupancy. Location of Property: Right-of-Way at the West Side of Cox 'Neck Road, Mattituck, NY; County Tax Map Parcel lO00-113-07-part of 012. Vote of the Board: Ayes: Messrs. Goehringer~ Doyen and Sawicki. {Members Grigonis and Doyen were absent.) This resolu- tion was adopted by unanimous vote of the members present. June 13, 1984 0el 3 SHEPARD M* SCHEINBERG ~~, NEW YORK Octobor 1, 1985 Southold Town Planning Board Town of Southold Town Hall Southold, New York 11971 Att: Diane M. Schultze, Secretary Re: Property Of Wiliiam'Chudiak Dear Ms. Schultze: In accordance with .your letter of August 14, 1985, I enclose herewith four applications for lot line changes to- gether with four checks for the filing fee of $50.00 each, We Understand that when approved, there will be a re- quirement that a covenant be filed to the effect that each of the parcels will merge with thecontiguous parcel on the east which fronts on Cox Neck Road, and we will assume that the approval will be made conditional upon such filing, and the co._venants will be filed once the approvals have been given. I Understand that it is not necessary for me to be preseht when these applications are heard since they are self- explanatory. If this is incorrect, please let me know. Very Emil F. DePetris November 6, 1985 Town Planning Board Town of Southold Southold, New York 11971 Att: Ms. Dianne M. Schultze Secretary Re: Proposed lot line changes (William Chudiak) Dear Ms. Schultze: In accordance with our telephone conversation of today, the following is the language of a covenant which we intend to insert in any deed made by the Chudiaks to the owner of the adjacent parcel and we understand that any approval by the Planning Board of the lot line changes will be subject to the requirement that the deeds which convey the Chudiak property contain this covenant~ "This conveyance is subject to the following covenant and restriction which shall run with the land: The parcel hereby conveyed shall merge with premises of the grantee contiguous thereto on the east and the 2 parcels shall thereupon be deemed to be one parcel for purposes of the zoning ordinance of the Town of Southold, so that under the present provisions of the zoning ordinance of the Town of Southold only one residence, together with accessory structures, may be constructed and maintained upon the said two parcels which are being merged into one parcel." EFD:sr Very truly yours, Emil F. DePetris S~TY Southold, N.Y. 11971 (516) 765-1938 December 17, 1985 Mr. Emil Depetris, Esq. 220 Roanoke Avenue Riverhead, NY 11901 Re: Chudiak to Zabicky located at Mattituck Dear Mr. Depetris: The following action was taken by the Southold Town Planning B6ard, Monday, December 16, 1985. RESOLVED that the Southold Town Planning Board approve the lot-line change to add 25,000 square feet from the property of Chudiak to the property now or formerly of Zabicky, located at Mattituck,subject to the following conditions: 1. That the property of ChUdiak will be conveyed to and merged with the contiguous house lot to the East, now or formerly of Zabicky 2. That only one (1) residence together with accessory structures may be constructed and maintained upon the two parcels which will become merged into one. 3. That the above covenants and restrictions be included the deed and on the survey map for the lot line change. When we are in receipt of the amended surveys as requested in condition No. 3, the Chairman will endorse the approval on the survey. Please forward six (6) prints of the amended surveys. If you have any-questions, please don't hesitate ko c6ntact our office. Very truly yours, BENNETT ORLOWSKI, JR. , CHAIRMAN SOUTHOLD ToWN PLANNING BOARD December 17, 1985 Mr. Emil Depetris, Esq. 220 Roanoke Avenue Riverhead, NY 11901 Re: Chudiak to Wells Dear Mr. Depetris: The following action was taken by the Southold Town Planning Board, Monday, December 16, 1985. RESOLVED that the Southold Town Planning Board approve the lot-line change to add 12,500 square feet from the property of Chudiak to the property now or formerly of Wells subject to the following conditions: 1. That the property of Chudiak will be conveyed to and merged with the contiguous house lot to the East, now or formerly of Wells. 2. That only one (1) residence together with accessory structures may be constructed and maintained upon the two parcels which will become merged into one. 3. That the above covenants and restrictions be included in the deed and on the survey map for the lot line change. When we are in receipt of the amended surveys as requested in condition No. 3, the Chairman will endorse the approval on the survey. Please forward six (6) prints of the amended surveys. If you have any questions, our office. please don't hesitate to contact Very truly yours, SOUTHOLD TOWN PLANNING BOARD SCtIEINBERG, SCHNEp$, DE PI~TI~is & DE P~s October 1, 1985 Southold Town Planning Board Town of Southold Town Hall Southold, New York 11971 Att: Diane M. Schultze, Secretary Re: Property Of William Chudi~k Dear Ms. Schultze: In accordance with your.letter of August 14. 1985, I enclose berewith four applzcatzons for lot line changes to- gether wzth four checkS for the filzng fee of $50.00 each. We understand that when approved, there will be a re- quirement that a covenant be filed to the effect that each of the parcels will merge with the contiguous parcel on the east which fronts on Cox Neck Road, and we will assume that the approval will be made conditional upon such filing, and the co._venants will be filed once the approvals have been given. I understand that it is not necessary for me to be present when these applications are heard since they are self- explanatory. If this is incorrect, please let me know. Emil F. DePetris EFD:bgm Encls. 7 SOI~EINBE]~O, SOI-INEP$, Dc. PE'l'aIS & DE PETRIS November 6, 1985 Town Planning Board Town of $outhold Southold, New York 11971 Att: Ms. Dianne M. Schultze Secretary Re: Proposed lot line changes (William Chudiak) Dear Ms. Schultze: In accordance with our telephone conversation of today, the following is the language of a covenant which we intend to insert in any deed made by the Chudiaks to the owner of the adjacent parcel and we understand that any approval by the Planning Board of the lot line changes will be subject to the requirement that the deeds which convey the Chudiak property contain this covenant: "This conveyance is subject to the following covenant and restriction which shall run with the land: The parcel hereby conveyed shall merge with premises of the grantee~ contiguous thereto on the east and the 2 parcels shall thereupon be deemed to be one parcel for purposes of the zoning ordinance of the Town of Southold, so that under the present provisions of the zoning ordinance of the Town of Southold only one residence, together with accessory structures, may be constructed and maintained upon the said two parcels which are being merged into one parcel." EFD:sr Very truly yours, Emil F. DePetris Southold, N.Y. 11971 (616) 765-1938 October 15, 1985 Mr. Emil F. DePetris Scheinberg, Schneps, and Depetris Attorneys at Law 220 Roanoke Avenue P.O. Box 599 Riverhead, NY 11901 DePetris Re: Lot=line changes William Chudiak Dear Mr. DePetris: We are in receipt of the applications for the lot-line changes for William Chudiak and they have been reviewed by the Planning Board. The Board requests more information on the surveys. Please refer to the enclosed list for the items to be included on the survey. If you have any questions, please don't hesitate to contact our office. Very truly yours, ORLOWSKI, JR. , CHAIRMAN SOUTHOLD TOWN PLANNING BOARD By Diane M. Schultze, Secretary enc. The following items are change: ( ) ( ) ( ) ( ) ( ) LOT-LINE CHANGE to be submitted on the survey for a lot-line Key Map Lot, block, and section number from tax map, scale and north arrow Name and address of the owner of record Name and address of the person preparing the map (certified engineer, land surveyor, architect, etc.) Property descriptions, dimensions, bearings, square footage of the property being changed and property where additional square footage is coming from. Existing zoning Areas subject to flooding Existing buildings and site improvements, (ie fences, hedges) Indicate the existing lot line (dotted line) with the bearing and distance and the proposed lot line (solid line) with the new bearing and distance. Location and name of existing streets or right-of-way adjacent to the property. Existing spot grades The following information is to be submitted with the application for a lot-line change: Written and signed letter, notorized, by owners of properties in question approving of the change and reasons for the change. Proposed covenants and restrictions indicating that upon Planning Board approval, the property will be merged. Any existing covenants applying to the property. Form letter regarding drainage, roads, and grading, see attached Short Environmental Assessment Form, Part I, see attached Application, three pages, last page notoriz~d , see attached Southold, N.Y. 11971 (516) 765-1938 October 15, 1985 Mr. Emil F. DePetris Scheinberg, Schneps, and Depetris Attorneys at Law 220 Roanoke Avenue P.O. Box 599 Riverhead, NY 11901 DePetris Re: Lot=line changes William Chudiak Dear Mr. DePetris: We are in receipt of the applications for the lot-line changes for William Chudiak and they have been reviewed by the Planning Board. The Board requests more information on the surveys. Please refer to the enclosed list for the items to be included on the survey. If you have any questions, please don't hesitate to contact our office. Very truly yours, BENNETT ORLOWSKI, JR. , CHAIRMAN SOUTHOLD TOWN PLANNING BOARD By Diane M. Schultze, Secretary enc. OCT 3 1985 i'dAP OF Pr2OPE2T¥' 3.-.U I~LV EYE D FOE~. 12t 7~\ AT I--IATTI J2. :-~;-',~, c3 TAt,,, NIAF log')' Jl3-7- I:::'/0 IZ, Southold Town Planning Board Town Hail Southold, New York 11971 Gentlemen: Re: William Chudiak (w/s land of Wells Lot line change 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, W ILLIAb{ CHUDIAK and AN_~/~HUDIAK WILLIAM CHUDIAK OCl 3 1985 APPLICATION FOR APPROVAL OF PLAT (Lot line change) To the Planning Board of the Town of Southold: The undersigned applicant hereby applies for ~(X~t~K(final)approval ora subdivision plat ln accordance with Article 16 of the To~vn La~v 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 DNA 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 Count), Clerk's office as follows: Liber 4155 59 8/2/56 ........................ Page ...................... On Liber ........................ Page ...................... On Liber ........................ Page ............ On Liber ........................ Page ...................... On Liber .................. Page On as devised under the Last Will and Testament of ....................................... or as distributee ........................................................................ 5. The area of the land is ..1..2.,.5..0.0. ........ ~ square feet 6. All taxes which are liens on the land at the date hereof have been paid~,-~ll~ ............ 7. The land is encumbered by ..... $..o.B.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 are no other encumbrances or liens against the land :~J~l~tK ........................ 9. The land lies in the following zoning use districts 10. No part of the land lies under water ~vhether tide ~vater, stream, pond water or otherwise, II. The applicant shall at his expense install all required public improvements. 12. The land (M~le~ (does not) lie in a Water District or Water Supply District. Name of Dis- trict, if within a District, is 13. Water mains will be laid by DNA and (a) (no) charge will be made for installing said mains. 14. 15. 16. 17. 18. 19. 20. 21. Electric lines and standards will be installed by DNA ..................................... and (a) (no) charge will be made for installing said lines. Gas mains will be installed by .. DNA and (a) (no) charge will be made for installing said mains. If streets shown on the plat are claimed by the applicant to be existing public streets in the Suffolk County Highway system, annex Schedule "B" hereto, to show same. 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. There are no existing buildings or structures on the land which are not located and shown on the plat. Where the plat shows proposed streets which are extensious 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. In the course of these proceedings, the applicant will offer proof of title as required by Sec. 335 of the Real Property Law. Submit a copy of proposed deed for lots showing all restrictions, covenants, etc. Annex Schedule "D". 22. The applicant estimates that the cost of grading' and required public improvements will be DNA. $ .......... as itemized in Schedule "E" hereto annexed and requests that the maturity of the Performance Bond be fixed at . .D.N..A ......... years. The Performance Bond will be written by a licensed surety company unless otherwise shown on Schedule "F". DATE ..S.e.p..t.e..m.b..e.r. _2 ~' 1985 William Chudiak and Anne..C~diak (Name of Applicant) ~ / ~gnatdr~ an?i~'Title) William Chudiak ~ M~ t.t~ i.~u c.k o.. N.ew..Yozk.. ll 9 5.2 ............. (Address) STATE OF NEW YORK, COUNTY OF . .. SUFFOLK ............................. , SS: On the --~'J September ~ ........... 19. ~.~.., before me personally came .................. day of ................. WILLIAM CHUD IAK ...................... to me known to be the individual described in and who executed the foregoing instrument, and acknowledged that ... ~.~ ...... executed the same. EMIL F. STATE OF NEW YORK, COUNTY OF ........................ ~t~?n ~irea On the ................ day ............ of .............. , 19 ...... , before me personally came ....................... to me known, who being by me duly sworn did de- pose and say lhat ............ resides at No ..................................................... ................................ that .......................... is the .......... 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. Notaiy ' P~blic ........................ For UNLISTED ACTIONS Only PAR? I PtoJe¢! Intormntlon (To be completed by ^ppJicant ot Project 1. Applicant/sponsor 2. Project Name William and Anne Chudiak ~ine 3. Project location: YORK STATE DEP ~ PROJECT I D NUMBER State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM Mu.~cipali~ Mat tituck 4 Is pro sed action: ~°New [] Expansion [] Modification/alteration chan__~ Wells Co..~ Suffolk 5. Describe project briefly: Lot line change. Parcel is to be added to adjacent land on the East owned by Theodore R. Wells, Jr. and Rita Wells. 6 Precise location (road intersections, prominent randmarks, etc. or provide map) West of Cox Neck Road, Mattituck, New York 7 Amount of land affected:Less t an one acre Initially . acres Ultimately ~ Will proposed action comply w~th ex~stmg zonmg or other existinB land use restrictionsf J~ Yes [] No If No, describe briefly To be added to existing lot 9. What is present land use in vicinity of project~ [] Residential [] Industrial [] Commercial [] Agriculture [] Parkland/open space Describe: [] Other 10. Does action involve a permB/approval, or funding, now or u t merely, from any other governmental agency (Federal, state or local)? [] 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 ~] No If yes, list agency name and permit/approval type 12 As result of proposed action will existing permit/approval require modification,' I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: William and Anne ChujLi~~ Date: 9/C~/85 ['~'~'he action I$ In the Coastal Area, and you are a state agency, complete Coastal Assessment Form before proceeding with this assessment the OVER PART II Environmental Asse~ent (To be completed by Agency) A. action exceed any Type I threshold in 6 NYCRR. part 617.12;[ If yes. coordinate the review process and use the FULL/LONG FOR/~ EAF. [] Yes [] No . . . . · . If No, a negative declaration may be superceded by another 6. Will action receive coordinated rewew as prowded for Unhsted Actions m 6 NYCRR, Part 617 ?;[ involved action C2. Historic, archeological, visual or aesthetic, or other natural or cultural resources; agricultural districts; or community or neighborhoocl character;[ Explain briefl C3. Vegetation or fauna, movement of fish 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. Secondary, cumulative, or other effects not identified in C1~67 Explain briefly. C7. A change in use of either quantity or type of energy? 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. Enspre 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/LONG FORM 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 here, and on attachments as necessary, the reasons supportng this determination: Agency Preparer's Name Date Preparer's Signature/TiUe .1 N£tJ 6)~C k:2 N-893:)¢2 20 E. :T '-b '0 NEUDEC~.~ At'