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Soulhold, N. Y. 11971
(516) 765-1938
October 23, 1986
Mr. Robert Waddington
c/o Metro Rental
Mattituck, NY 11952
RE: Site Plan for Metro Rental
Dear Mr. Waddington:
The following action was taken by the Southold Town Planning
Board, Monday, October 20, 1986.
RESOLVED that the Southold Town Planning Board refer
the site plan for Robert and Cornelia Waddington for construction
of an addition on an existing building known as "Metro Rental"
located at Main Road, Mattituck to the Building Department
for certification. Site plan dated as amended July 17, 1986.
If you have any questions, please don't he~itate to contact
our office.
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Very trUly yours,
~ding D"partm"n'
.;:ri~rLttf (QrtJswA~,9vdu-
BENNETT ORLOWSKI, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Diane M. Schultze, Secretary
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Southold lown Board of Appeals
MAIN ROAO. STATE ROAO 25
SOUTHOLD. L.I.. N.Y. 11971
TELEPHONE 1516) 765,1809
ACTION OF THE ZONING BOARD OF APPEALS
Appeal No. 3534
Application Dated
TO:
July 16, 1986
Wi 11 i am D. Moore, Esq. as
Attorney for ROBERT WADDINGTON
P.O. Box 973 - Main Road
Cutchogue, NY 11935
[Appellant (s) J
At a Meeting of the Zoning Board of Appeals held on October 10, 1986,
the above appeal was considered, and the action indicated below was taken
on your [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
pog Request for Variance to the Zoning Ordinance
Article III, Section 100-31, Bulk Schedule and
Article VII, Section 100-71, Bulk Schedule
[J Request :t;or
Application of ROBERT WADDINGTON for a Variance to the Zoning Ordi-
nance, Article III, Sectlon 100-31, Bulk Schedule for permission to
construct addition to existing building with insufficient side and
rear yard setbacks, at 13175 Main Road, Mattituck, NY; County Tax Map
Parcel No. 1000-140-03-038; "B-1" General Business Zonin9 District.
WHEREAS, a public hearing was held and concluded on September 11,
1986 in the Matter of the Application of ROBERT WADDINGTON under
Appea 1 No. 3534; and .
WHEREAS, at said hearing all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the board has carefully considered all testimony and
documentation submitted concerning this application; and
WHEREAS, the board members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the board made the followin9 findings of fact:
'1. The premises in question is a described parcel containing
a total area of 16,580 sq. ft. and frontage along the north side
of Main Road, Mattituck of 84.22 feet, lot width along the rear
property line of 63.66 feet, and average lot depth of 221 feet.
2. The subject premises is located in the "B-1" General
Business Zoning District and is presently improved with a
structure as shown by survey amended June 30, 1986 submitted
with the'~pplitatlon ~ith floor area Of 3200~ sq. ft., having
setback of.1.4 feet from the .westerly si,de 1 i ne, 18. feet from
the easte~ly slde line, five feet from the northeast corner of
the existing building to the closest point at the northerly
portion of the easterly side line, and 89~ feet to the rear
property line.
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DATED: October 10, 1986.
(CONTINUED ON PAGE TWO)
Form ZB4 (rev. 12/~~.
CHAIRMAN, SOUTHOLD TOWN ZONING BOARD
OF APPEALS
.
~ . ."
~age 2 - Appeal No. 3534
Matter of ROBERT WADDINGTON
Decision Rendered October 10, 1986
3. By this application, appellant requests permission to
locate a 70' by 30' wide addition at the rear of the existing
building with an insufficient sideyard setback from the easterly
property line (at its closest point) at two feet and with an
insufficient rearyard setback at 19 feet (at its closest point).
The westerly sideyard area along the proposed addition will
remain open and unobstructed 30 feet in width for turnarounds
and manuevering of vehicles and equipment.
4. Article VII, Section 100-71, Bulk Schedule of the Zoning
Code requires a minimum sideyard at 25 feet, total sideyards at
50 feet~ and minimum rearyard at 35 feet. The relief requested
for the easterly sideyard is 23 feet, or 92% of a variance from
the requirement. The relief requested for the total sideyards
is 18 feet, or 36% of the requirement. The relief requested
for the rear yard is 16 feet, or 55% of the requirement.
5. It is the consensus of the board that the easterly
side yard must remain open five feet to allow for necessary
access for emergency reasons, and therefore condition this
approval on a minimum sideyard at the easterly side at five
feet and total sideyards at not less than 35 feet for the
new addition.
In considering this appeal, the board also finds and deter-
mines: (a) the circumstan~es of the property are unique and
lend to the practical difficulties; (b) the variance as condi-
tionally granted will not in turn cause a substantial effect of
increased population density or be adverse to the safety, health,
welfare, comfort, convenience, order of the town; (c) there
will be no substantial detriment to adjoining properties; (d)
the relief requested is not substantial; (e) in view of the
above factors, the interests of justice will be served by
granting the variance, as conditionally noted below.
Accordingly, on motion by Mr. Douglass, seconded by
Mr. Grigonis, it was
RESOLVED, that a Variance for an insufficient easterly
sideyard setback at five feet, insufficient total sideyards
at 35 feet, and insufficient rearyard setback at 19 feet,
for the proposed addition applied in the Matter of the Appli-
cation of ROBERT WADDINGTON under Appeal No. 3534, BE AND
HEREBY IS APPROVED SUBJECT TO THE FOLLOWING CONDITIONS:
1. Easterly sideyard setback of new addition to be not
closer than five feet, open and unobstructed;
2. Northerly rearyard setback of new addition to be
not closer than 1.9 feet ~s applied;
3. Westerly sideyard setback of new construction to be
not closer than 30 feet as applied, open and unobstructed at
all times;
4. Withdrawal of Appeals No. 3100 and 3101.
Vote of the Board:
Douglass and Sawicki.
due to illness.) This
Ayes: Messrs. Goehringer, Grigonis,
(Member Doyen, Fishers Island, was absent
resolution was duly adopted.
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ER RD P. GOEH INGER, - 7\IRMAN
October 13, 1986
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Southold, N.Y. 11971
(516) 765-1938
October 23, 1986
Mr. Robert Waddington
c/o Metro Rental
Mattituck, NY 11952
RE: Site Plan for Metro Rental
Dear Mr. Waddington:
The following action was taken by the Southold Town Planning
Board, Monday, October 20, 1986.
RESOLVED that the Southold Town Planning Board refer
the site plan for Robert and Cornelia Waddington for construction
of an addition on an existing building known as "Metro Rental"
located at Main Road, Mattituck to the Building Department
for certification. Site plan dated as amended July 17, 1986.
If you have any questions, please don't hesitate to contact
our office.
Very truly yours,
:i31A1Jlttt (Qr&swAiU.-9v~
BENNETT ORLOWSKI, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Diane M. Schultze, Secretary
cc: Building Department
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Southold Town Board of Appeals
MAIN ROAD. STATE ROAO 25
SOUTHOLD. L.I.. N.Y. 11971
TELEPHONE 15161 765.1809
APPEALS BOARD
MEMBERS
GERARD P. GDEHRINGER, CHAIRMAN
CHARLES GRIGONIS, JR,
SERGE DOYEN, JR.
ROBERT J. DOUGLASS
JOSEPH H. SAWICKI
July 21, 1986
William D. Moore, Esq.
Ric,hard F. Lark Law Office
Box 973, Main Road
Cutchogue, NY 11935
Re: Appeal No. 3534 - Robert and Cornelia Waddington (Variance)
Dear Sirs:
This letter will acknowledge receipt of your recent appli-
cation. The members of the.Board of Appeals .!'Ii11 be conducting
field inspections and environmental reviews as .1I!.ay be required
by State and local laws prior to scheduling your~pp1ication for
a public hearing.
It is requested in the interim that you proceed with the
[XX] Planning Board []N.Y~S. D.E.G~ [ ] Town Trustees
in order that they may .sub[11it tneir written comments or recom-
mendations as early as possible. Upon receipt of their input,
your application will be scheduled for the next available hear-
ing date.
If the above document(s) are submitted by mid-August,
it is expected that the public hearing would be held about the
early part of September~Acopy of the notice of hearings as
published in the Long Is1andT.rave1er-Watchman and the Suffolk
Times will be sent to you as confirmation.
Please feel free to call at any time if you have any questions.
Yours very truly,
GERARD P. GOEHRINGER
CHAIRMAN
Enclosure (Receipt)
cc: Planning Board
/
By Linda Kowalski
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Southold, N.Y. 11971
(516) 765-1938
May 12, 1986
Mr. and Mrs. Robert Waddington
Main Road
Mattituck, NY 11952
Re: Site Plan for
Metro Rental
Dear Mr. and Mrs. Waddington:
The_site plan submitted for an addition on the
existing Metro Rental building has been reviewed.
The items indicated on the enclosed check list
must be included on the survey by a surveyor prior to
scheduling this matter on the Planning Board's agenda.
Would you please have the surveys revised and
submit six (6) to our office. Upon receipt of same,
we will schedule this matter on the next available
agenda.
Please contact our office if you have any questions.
Very truly yours". (1. .
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BENNETT ORLWOSKI, JR., CHAIRMAN
SOUTH OLD TOWN PLANNING BOARD
By Diane M. Schultze, Secretary
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SITE PLAN ELEMENTS
5100-134 Town Code
T+em0 Chec 'Ke<;;\ m\J"b+ \oe
--,- luoled 011 UUllJe~,
\ no () Lot, block,
tax records
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and section number, if any, or the property taken from
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Name and address of the owner of record
Name and address of the person preparing the map
Date, North arrow and written and graphic scale
Sufficient description or information to precisely define the boundar;
of the property. All distances shall be in feet and tenths of a foot.
All angles shall be given to the nearest ten seconds or closer. The
error of closure shall not exceed one in ten thousand.
The locations, name, and existing width of adjacent streets and curbli
The location and owners of all adjoining lands, as shown on the latest
tax records
Location, width and purpose of all existing and proposed easements, se
reservations, and areas dedicated to public use within or adjoining pro
A complete outline of existing deed restrictions or covenants applying
the property
Existing zoning
Existing contours at. intervals of five or less, referred to a datum
satisfactory to the Board
Approximate boundaries of any areas subject to flooding or stormwater
Location of existing watercourses, marshes, wooded areas, rock outcrop
isolated trees with a diameter of eight inches or measured three feet
above the base of the trunk and other significant existing features.
Location of ~ and outlines of structures, drawn to scale on and
within one hundred (100) feet of the lots.
Paved areas, sidewalks, and w~hicular access between the site and publ
streets
Locations, dimensions, grades and flow direction of existing sewers, c
and waterlines as well as other underground and above ground utilities
within and adjacent to the property.
-Other existing development, including fences, landscaping and screenin
The location of proposed buildings or structural improvement
The location and design of all uses not requiring structures
such as off street parking and loading areas.
The location, direction, power and time of use of any proposed outdoor
lighting or public address systems.
The location of, and plans for, any
outdoor signs
The location and arrangement of proposed means of access and egress,
including sidewalks, driveways or other paved areas; profiles indicati,
grading and cross sections showing width of roadway, location and widtl
of sidewalks and lcoation and size of water and sewer lines.
OVER.. .
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Site plan elements cont.
(HOO-134)
(V)
( /)
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( )
( )
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Any proposed grading, screening and other landscaping including types
and locations of proposed street trees.
The location of all proposed waterlines, valves and hydrants and of
all sewer lines or alternate means of water supply and sewage disposal
and treatment.
An outline of any proposed deed retrictions and/or covenants.
Any contemplted public improvements on or adjoining the property.
If the site development plan indictes only a first stage, a supplementary
plan shall indicate ultimate develoment.
Any other information deemed by the Planning Board necessary to determine
conformity of the site plan with the intent and regulations of this chapter.
V\E'Q~Q l\1:\loa-/€ He- squoue.-\1atz,(Jk'.- of ..e;:JzJ( .
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Southold. N. Y. 11971
(516) 765-1938
August 6, 1986
Mr. and Mrs. Robert Waddington
Main Road
Mattituck, NY 11952
Re: Site Plan for
Metro Rental
Dear Mr. and Mrs. Waddingron:
It is the consensus of the Board to cOnduct a field inspection
of the premises prior to any further action or recommendation.
Please contact our office if you have any questions.
Very truly yours,
&-.vN:tf ()~~) {A- 'J1V
BENNETT ORLWOSKI, JR., CHAIRMAN
SOUTHOLD TOWN PLANNING BOARD
By Melissa Spiro
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SITE PLAN ELEMENTS
~100-134 Town Code
'7 n(oJe -bo bz a'll
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or the property taken from ..:;Jf vefi
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Lot, block, and section number, if any,
tax records
Name and address of the owner of record
Name and address of the person preparing the map
Date, North arrow and written and graphic scale
Sufficient description or information to precisely define the boundaries
of the property. All distances shall be in feet and tenths of a foot.
All angles shall be given to the nearest ten seconds or closer. The
error of closure shall not exceed one in ten thousand.
./
The locations, name, and existing width of adjacent streets and curblines
The location and owners of all adjoining lands, as shown on the latest
tax records
Location, width and purpose of all existing and proposed easements, setbacks,
reservations, and areas dedicated to public use within or adjoining property.
A complete outline of existing deed restrictions or covenants applying to
the property
Existing zoning
Existing contours at intervals of five or less, referred to a datum
satisfactory to the Board
Approximate boundaries of any areas subject to flooding or stormwater overflc
Location of existing watercourses, marshes, wooded areas, rock outcrops
isolated trees with a diameter of eight inches or measured three feet
above the base of the trunk and other significant existing features.
Location of uses and outlines of structures, drawn to scale on and
within one hundred (100) feet of the lots.
Paved areas, sidewalks, and wehicular access between the site and public
streets
Locations, dimensions, grades and flow direction of existing sewers, culvert~
and waterlines as well as other underground and above ground utilities
within and adjacent to the property.
Other existing development, including fences, landscaping and screening
The location of proposed buildings or structural improvement
The location and design of all uses not requiring structures
such as off street parking and loading areas.
The location, direction, power and time of use of any proposed outdoor
lighting or public address systems.
The location of, and plans for, any
outdoor signs
The location and arrangement of proposed means of access and egress,
including sidewalks, driveways or other paved areas; profiles indicating
grading and cross sections showing width of roadway, location and width
of sidewalks and lcoation and size of water and sewer lines.
OVER.. .
,
/
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,
,
~
,
.
Site plan elements cont.
(~IOO-134)
(
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Any proposed grading, screening and other landscaping including types
and locations of proposed street trees.
The location of all proposed waterlines, valves and hydrants and of
all sewer lines or alternate means of water supply and sewage disposal
and treatment.
An outline of any proposed deed retrictions and/or covenants.
Any contemplted public improvements on or adjoining the property.
If the site development plan indictes only a first stage, a supplementary
plan shall indicate ultimate develoment.
Any other information deemed by the Planning Board necessary to determine
conformity of the site plan with the intent and regulations of this chapter.
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OCT 14 1~89-
Southold lown Board of Appeals
MAIN ROAD. STATE ROAD 2S
SOUTHOLD. L.I.. N.Y. 11971
TELEPHONE 1516) 765,1809
ACTION OF THE ZONING BOARD OF APPEALS
Appeal No. 3534
Application Dated
TO:
July 16, 1986
William D. Moore, Esq. as
Attorney for ROBERT WADDINGTON
P.O. Box 973 - Main Road
Cutchogue, NY 11935
[Appellant (s)]
At a Meeting of the Zoning Board of Appeals held on October 10, 1986,
the above appeal was considered, and the action indicated below was taken
on your [] 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
[XX] Request for Variance to the Zoning Ordinance
Article III, Section 100-31, Bulk Schedule and
Article VII, Section 100-71, Bulk Schedule
[] Request :tior
Application of ROBERT WADDINGTON for a Variance to the Zoning Ordi-
nance, Article III, Sectlon 100-31, Bulk Schedule for permission to
construct addition to existing building with insufficient side and
rear yard setbacks, at 13175 Main Road, Mattituck, NY; County Tax Map
Parcel No. 1000-140-03-038; "B-1" General Business Zoning District.
WHEREAS, a public hearing was held and concluded on September 11,
1986 in the Matter of the Application of ROBERT WADDINGTON under
Appea 1 No. 3534; and
WHEREAS, at said hearing all those who desired to be heard
were heard and their testimony recorded; and
WHEREAS, the board has carefully considered all testimony and
documentation submitted concerning this application; and
WHEREAS, the board members have personally viewed and are
familiar with the premises in question, its present zoning, and
the surrounding areas; and
WHEREAS, the board made the following findings of fact:
'1. The premises in question is a described parcel containing
a total area of 16,580 sq. ft. and frontage along the north side'
of Main Road, Mattituck of 84.22 feet, lot width along the rear
property 1 ine of 63.66 feet, and average lot depth of 221 feet.
2. The subject premises is located in the "B-1" General
Business Zoning District and Is presently Improved with a
structure as shown by survey amended June 30, 1986 submitted
with the'applicatlon ,with floor area oJ 3200:1: sq. ft., having
setback of .1.4 feet from the ,westerly si.de 1 I ne, 18 feet from.
the easterly slde line, five feet from the northeast corner of
the existing building to the closest point at the northerly
portion of the easterly side line, and 89:1: feet to the rear
property line.
iP~~
DATED: October 10, 1985.
(CONTINUED ON PAGE TWO)
Form ZB4 (rev. 12/~~.
CHAIRMAN, SOUTHOLD TOWN ZONING BOARD
OF APPEALS
,..
..... rage 2 - Appeal No. 3534
Matter of ROBERT WADDINGTON
Decision Rendered October 10, 1986
3. By this application, appellant requests permission to
locate a 70' by 30' wide addition at the rear of the existing
building with an insufficient sideyard setback from the easterly
property line (at its closest point) at two feet and with an
insufficient rearyard setback at 19 feet (at its closest point).
The westerly sideyard area along the proposed addition will
remain open and unobstructed 30 feet in width for turnarounds
and manuevering of vehicles and equipment.
4. Article VII, Section 100-71, Bulk Schedule of the Zoning
Code requires a minimum sideyard at 25 feet, total sideyards at
50 feet~ and minimum rearyard at 35 feet. The relief requested
for the easterly sideyard is 23 feet, or 92~ of a variance from
the requirement. The relief requested for the total sideyards
is 18 feet, or 36% of the requirement. The relief requested
for the rear yard is 16 feet, or 55% of the requirement.
5. It is the consensus of the board that the easterly
side yard must remain open five feet to allow for necessary
access for emergency reasons, and therefore condition this
approval on a minimum sideyard at the easterly side at five
feet and total sideyards at not less than 35 feet for the
new addition.
In considering this appeal, the board also finds and deter-
mines: (a) the circumstan~es of the property are unique and
lend to the practical difficulties; (b) the variance as condi-
tionally granted will not in turn cause a substantial effect of
increased population density or be adverse to the safety, health,
welfare, comfort, convenience, order of the town; (c) there
will be no substantial detriment to adjoining properties; (d)
the relief requested is not substantial; (e) in view of the
above factors~ the interests of justice will be served by
granting the variance, as conditionally noted below.
Accordingly, on motion by Mr. DOU9lass, seconded by
Mr. Grigonis, it was
RESOLVED, that a Variance for an insufficient easterly
sideyard setback at five feet, insufficient total sideyards
at 35 feet, and insufficient rearyard setback at 19 feet,
for the proposed addition applied in the Matter of the Appli-
cation of ROBERT WADDINGTON ~nder Appeal No. 3534, BE AND
HEREBY IS APPROVED SUBJECT TO THE FOLLOWING CONDITIONS:
1. Easterly sideyard setback of new addition to be not
closer than five feet, open and unobstructed;
2. Northerly rearyard setback of new addition to be
not closer than 19 feet BS applied;
3. Westerly sideyard setback of new construction to be
not closer than 39 feet as applied, open and unobstructed at
all times;
4. Withdrawal of Appeals No. 3100 and 3101.
Vote of the Board: Ayes: Messrs. Goehringer, Grigonis,
Douglass and Sawicki. (Member Doyen, Fishers Island, was absent
due to illness.) This resolution was duly adopted.
*
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~~~1i~t'~;i~AN
October 13,1986
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Southold, N.Y. 11971
(516) 765-1938
SITE PLAN
REQUIRED DOCUMENTS AND PROCEDURES
Required documents:
1. ~ix surveys wi~h all site plan elements, see attached list
---
2. Filing fee of $100
.... ---"..-
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3. Long Environmental Assessment, Part I see
attached
Procedure:
1. The above items are submitted to the Planning Board
2. The application is placed on the agenda for the Board's
review.
3. Field inspection made
4. Inspection report at next meeting
5. Recommendations on revisions or Board can forward site plan
to the Building Department for Certification
6. If certified, the Planning Board can take final action on
the site plan
7. If approved, the Chairman endorses the surveys when any
conditions have been met.
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PROJECT 1.0. NUMBER
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NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
DIVISION OF RECULA TORY AFFAIRS
State Environmental Quality Review MAY 9 - 7986
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
,
PART I Project Information (To be completed by Applicant or Project sponsor)
n,
1.
12. Project Name
3.
County
S' ~ 't- }:O/1<-
II,
04. Is proposed action:
o New 0 Expansion
S. Describe project briefly;
~odification/alteration
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6. Precise location (road intersections, prominent landmarks. etc. or provide map)
7. Amount of land affected:
Initially
acres
Ultimately
acres
8. Will proposed action comply with existing zoning or other existing land use restrictionsl
DYes 0 No If No, describe briefly
9. What is present land use in vicinity of projec~
o Residential 0 Industrial p..Commercial
Describe:
o Agriculture
D Parkland/open space
D Other
10. Does action involve a permit/approval, or funding, now or ultimately, from any other governmental agency (Federal, state or local)l
~ Yes D No If yes, list agency{s) and permit/approvals
11. Does any aspect~the action have a currently valid permit or approvall
D Yes ~o If yes, fist agency name and permit/approval type
^pplicant/~ponsor
isting permit/approval require modificationl
12
Y THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
j
h
Date:
A~ (' /fft
Signature:
II 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)
.J "
A. Does action exceed any Type r threshold in 6 NYCRR. Part 617.121
o Y.. 0 No
If yes, coordinate the review process and use the FULl/LONG FORM EAF.
8. Will action receive coordinated review as provided for Unlisted Actions in 6_NYCRR. Part 617.n
involved action.
DYe, 0 No
If No, a negative declaration may be superceded by ano;
\
C. Could action result in ANY adverse effects on, to, or arising from the following: (Answers may be handwritten. if legible)
C1. Existing air quality, surface or sraunclwater quality or quantity, noise levels. existing traffic patterns, solid waste production or disposal. potential for erasi
drainage or flooding problems? Explain briefly:
C2. Historic, archeological, visual or aesthetic. or other natural or cultural resources; agricultural districts; or community or neighborhood character? Explain bri-
C3. Vegetation or fauna, movement of fish or wildlife species, siKnificant habitats, or threatened or endangered species? Explain briefly:
C4. A communitys eXistinK plans or goals as officially adOPted, or a chanKe 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 actionl Explain briefly.
C6. Secondary. cumulative, or other effects not identiffed in C1-C6l Explain briefly.
C7. A change in use of either quantity or type of energyl Explain briefly.
PART III Determination 01 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 (Le. urban or rura/); (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.
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:
Agencv Name
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AKencv Preparer's Name
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