HomeMy WebLinkAboutTR-3748Dear Sir/Madam,
My husband and I recently purchased a home in Laurel, NY:
1810 North Oakwood Drive, 11948
There are three permits that need to be transferred from the seller's name (Martin
Sendlewski) into our name (Richard and Jill Collins)
When we purchased the property, the permits were not in the seller's name...they
actually had to be transferred to our seller's name from the previous seller. Included is the
board approval to have the permits transferred from seller 1 (Bastone) to seller 2
(Sendlewski). This was taken care of in December, 2011
At this time, we would like to have the permits transferred from seller 2 (Sendlewski) to
us (Collins)
The permits in question are:
1) Wetland Permit #3748
2) Wetland Permit #6609
3) Permit # 7699A
We would appreciate it if you could put this on the agenda for the next board meeting.
Should you need to contact us, our address and phone number are as follows:
Richard and Jill Collins
10 Stuyvesant Oval
Apt. 12B
New York, NY 10009
Ph: 646-371-9199
Kind Regards, -
048579
,I d
~ m ~ Do lars $
~=~ _ _
James F. King, President
Bob Ghosio, Jrt, Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town Hail Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mamh 14, 2012
Mr. & Mrs. Richard Collins
10 Stuyvesant Oval
Apr. 12B
New York, NY 10009
RE:
SENDLEWSKI/COLLINS
WETLAND PERMIT #3748
1810 OAKWOOD DR., LAUREL
SCTM#127-6-8
Dear Mr. & Mrs. Collins:
The Southold Town Board of Trustees reviewed your application dated March 9, 2012
and APPROVES the request for a Transfer of Wetland Permit #3748 from Martin
Sendlewski to Richard & Jill Collins. as issued on April 27, 1989.
If you have any questions, please contact our office at (631) 765-1892,
Jame~ F. King, Presid~
Board of Trustees
JFK:lms
[2/29/2011 15:50 63[7651856 KEVIM40-ALJ~HLIN P;~E 03
December 14, 2011
TOW~ OF 8OUTHOL~
8outhold, New York 11g71-0969
TebJ~me (~31) ?e6-1~2
Mr. Jerry Clbulski
Century 21 Albeltson Realty
P,O. Box 598
Southold, NY 11971
RE:
BASTONE/SENDLEWSKI
WETLAND PER~IT 83748
1810 OAKWOOD R., LAUREL
$C'1'~127~-8
Dear Mr. Cibulskt:
The following a~lon was taken al the Souti~:~ld Tow~ Board of Trustees Regular
Meeting held on Wed., December 14, 2011:
RESOLVED, that the Southold Town Board of Trdstees APPROVES the requeat for a
Transfer of Wetland Permit #3748 from John & Eleanor Beato~e t~ Martin Sendlewski,
as issued on April 27, 1989.
If you have any questions, please ~ontact our office at (831) 765-1892.
Sincerely,
JMD:ImB
$outhold Town-TrUstees
NEW YORK
Anthartzattan
tbs Stets efNew Yed~ 1~3, e~ ~ ~ ~h ~:~ h
IN AND ~ TO~ WA~S ~D ~B~ ~ :~ h
~V~ OF~D, G~L OR O~GR ~
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19...~.., aK in ~e~ ~.h ~ ~ L....~. ................... ~ ~
~ 6~z 46t ~, 3~ z 1~~r~, 6' x lZ~
181~ ~ ~ve, ~ N.Y. .
Jill M. Doherty, President
Bob Ghosio, Jr., Vice-President
James F. King
Dave Bergen
John Bredemeyer
Town Hall Annex
54375 Main Road
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
December 14, 2011
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Mr. Jerry Cibuiski
Century 21 AIbertson Realty
P.O. Box 598
Southold, NY 11971
RE:
BASTONEISENDLEWSKI
WETLAND PERMIT #3748
1810 OAKWOOD R., LAUREL
SCTM#127-6-8
Dear Mr. Cibulski:
The following action was taken at the Southold Town Board of Trustees Regular
Meeting held on Wed., December 14, 2011:
RESOLVED, that the Southold Town Board of Trustees APPROVES the request for a
Transfer of Wetland Permit #3748 from John & Eleanor Bastone to Martin Sendlewski,
as issued on April 27, 1989.
If you have any questions, please contact our office at (631) 765-1892.
Sincerely,
Jill M.(~herty ~
President, Board of Tms~es
JMD:lms
Jill M. Doherty, President
Bob Ghosio, .h, Vice-President
Jmnes F King
Dave Bergen
John Bredemeye~
P.O Box 1179
Southold, NY 1 I071
Telephone (631 765-1892
Fax (631 ) 765-6641
Southold Town Board of Trustees
Field Inspection/Worksession Report
Date/Time: )"~ -'~ "~' l/
Jerry Cibulski on behalf of MARTIN SENDLEWSKI requests a Transfer of
Wetland Permit #3748 from John & Eleanor Bastone to Martin Sendlewski,
as issued on April 27, 1989. Located: 1810 Oakwood Dr., Laurel. SCTM#127-
6-8
Type of area to be impacted:
~Saltwater Wetland Freshwater Wetland
Sound Bay
Distance of proposed work to edge of wetland
Part of Town Code proposed work falls under:
__Chapt.275 __Chapt. 111 other
Type of Application: __ Wetland __Coastal Erosion
__Administrative__Emergency Pre-Submission __
__Amendment
Violation
Info needed:
Modifications:
Conditions:
Pres.gnt Were: P'J. Doherty . Ghosio
vj. BredemeyeE D. Dzenkowski
Form filled out in the field by
~/di'King ~D.
'/ooth~ Bergen,
Mailed/Faxed to:
Date:
November 04, 2011
Town of Southold
Trustees
Re.: TR-3748 Permit Dock
1810 N. Oakwood Laurel, NY
Request is hereby made by Jerry Cibulski, agent for homeowner, Martin Sendlewski, to
change the name on the above referenced permit from former owner Bastone, to Martin
Sendlewski.
Anything that can be done to schedule this item to be accomplished by the next Trustees
meeting would be appreciated.
Sin.ce,~y, ~
Jerry Cibulski
attachmenl
CENTURY 21 Albertson Realty
54280 Main Road - PO. Box 598 · Southold · NY 11971
Bu$ine$$631.1&$.380~ · Fax631.765,3803 · www.albertsonrealty.com
~I, Each office is independently owned and apelated
! Board Of $outhold Town Trustees
SOUT.HOLD, NEW YORK
PERMIT NO. 3..?...~.& .................
DATE: .A.. lq.~!!...;~.8..~,....~ ~ 8 9
Au 'horiza io
Pursuant to the provisions of Chapter 615 of the Laws 0f
the State of New York, 189~1; and Chapter 4.04 of fha Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND .ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted afb meeting held on ...A..P.~!....~7...~...
19....8.9.., and in consideration of the sum of $ .............................. paid by
of .......................................................................................... N. Y. and subiect fo the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
Construct 6' x 46' catwalk, 3' x 14' ramp, 6' x 12'
floating dock, install 10 pilings. Property located at
1810 Oakood Drive, Laurel, N.Y.
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes 'ifs Corporate Seal fo be
be subscribed by a majority of fl~
affixed, and these presents to
said Board as of this dat,e.
FRANK A. KUJAWSKI, JR., President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF $OUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
May 17, 1989
Mr. and Mrs. John Bastone
1810 Oakweed Road
Laurel, N.Y. 11948
Re: Application No. 1-1-89-127-g~-
Dear Mr. and Mrs. Bastone:
The following action was taken by the Board of Town Trustees
during their regular meeting held on April 27, 1989 regarding the
above matter:
WHEREAS, John and Eleanor Bastone applied to the Southold Town
Trustees for a permit under the provisions of the Wetland Ordinance
of the Town of Southold, application dated January 1, 1989, and
WHEREAS said application was referred to the Southold Town
Conservation Advisory Council for their findings and recommendations,
and
WHEREAS, a public hearing was held by the Town Trustees with respect
to said application on April 27, 1989 at which time all interested
persons were given an opportunity to be heard, and
WHEREAS, the Board members have personally viewed and are familiar
with the premises in question and the surrounding area, and
WHEREAS, the Board has considered all the testimony and documentation
submitted concerning this application, and
WHEREAS, the'Board has determined that the project as proposed will
not affect the health, safety and general welfare of the people of
the town,
-NOW, THEREFORE BE IT
RESOLVED that John and Eleanor Bastone BE AND HEREBY IS GRANTED
PERMISSION UNDER THE WETLAND ORDINANCE TO:
Construct 6' x 46' catwalk, 3' x 14' ramp, 6' x 12' floating dock,
and install 10 pilings to secure same.
This permit will expire two years from the .date it is signed if
work has not commenced by said date. Fees must be paid and permit
issued within six months of the date of this notification. Two
inspections are required and the Trustees are to be notified upon
completion of said project.
Please take notice that this declaration should not be
considered a determination made for any other department or agency
which may also have an application pending for the same or similar
project.
Permit will be issued upon payment of the following fees:
3' x 14' ramp ..................... $ 63.00
6' x 12' floating dock ............. 108.00
4 pilings below MHWM .............. 100.00
Total fees due .................... $271.00
Very truly yours,
Frank A. Kuja~ski, Jr.
President
Board of Town Trustees
FAK:jas
CC:
Bldg. Dept.
Conservation Advisory Council
file
Telephone
(516) 765-1801
Town Hall, 53095 Main Road
P.O. Box 1179
Southold. New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
To:
From:
Dated:
Re:
Southold Town Trustees
Southold Town Conservation Advisory Council
February 22, 1989
Recommendation of Wetland Applications
The following recommendation were made by the Southold Town Conservation
Advisory Council at its meeting held Thursday, February 16, 1989:
RESOLVED to recommend to the Southold Town Trustees approval of Wetland
Application No. 11-88-78-2-42 of Joseph J. Verwayen to construct a private
boat dock consinting of fixed elevated (3' above grade of marsh) catwalk,
hinged ramp and two floats secured by pilings.
RESOLVED to recommend to the Southold Town Trustess approval with
stipulations of Wetland Application No. 11-88-113-6-11 for Gerald Wood to
cpnstruct a timber dockconsisting of a 4' x 104' fixed elevated (min. 3.5')
walk with outer 5' x 36' "L" to west. Inner end of dockwill be approximately in line
with two existing timber pilings and 15' west of them. Propsoed dock will
extend a distance equal to exising adjacent dock to east.
The Council recommends approval with a further recommendation that natural
plantings in the area to be filled behing the railroad ties to avoid runoff
into the creek.
RESOLVED to recommend to the Southoid Town Trustees approval of Wetland
Application No. 1-1-89-127-68 of John and Eleanor Bastone to construct a floating
dock and landing.
RESOLVED to recommend to the Southold Town Trustees approval of Wetland
Application No. 10-88-123-4-5 of Thomas Palmer to replace a 53' x 3' catwalk
and 16' x 8' float and additioani work to dwelling consisting of a 12' x 37'
wood deck to rear of dwelling, 8' x 37' extension and 11' x 22' garage to front of
dwelling and move ekisting 8.4' x 8.4' shed to west side of lot ('further from
HWM).
RESOLVED to recommend to the Southold Town Trustees approval of Wetland
Application No. 1-3-89-56-5-36 of Mateo Lettunich to reinforce westerly
concrete and rock seawall, includein returns and reconstruct easterly rock
revetment with additional rocks and filter cloth. The Council recommends
approval since the work needs to be done but they would like to go on the
record that if the work was a new project they would have recommended
disapproval.
Page 2 '~
RESOLVED to recommend to the Southold Town Trustees approval of Wetland
Application No. 12-3-88-98-3-17 of Margaret McGwire to erect a two-story
garage 22'x28' and an adjacent 12' x 12' storage shed.
RESOLVED to recommend to the Southold Town Trustees approval of Wetland
Application No. 1-5-89-80-3-16 of Henry Arbeeny to remove and replace
(in same location and configuration) 60 I.f. of timber bulkhead, dredge a
manimum of 10 c.y. (to 3' below MLW) from an area 10' in front of bulkhead
and use spoil fro backfill, remove existing dock and replace with 3' x 12' hinged
ramp and 6' x 16' float secured by (2) 2-pile dolphins.
RESOLVED to recommend to the Southold Town Trustees approval of Wetland
Application No. 12-88-80-3-17 of John Van Vladrichen to remove and replace
in same location and configuration, 60 I.f. of timber bulkhead~ dredge a maximum of ~'
10 c.y. infront of bulkhead and use spoil' for backfill~ remove existing dock
and replace with 3' x 12' hinged ramp and 6' x 16' float secured by (2) 2-
pile dolphins.
217-72 77th Ave.
Bayside~ N.Y. 11364
April 14, 1989
Ms. Joan Schneider, Clerk
Southold Board of Town Trustees
Town Hall
Main Road
Southoldf N.Yo 11971
Re:
Matter of Eleanor & John Bastone
to construct floating dock at
1810 No. Oakwood Road, Laurel, N.Y.
Dear Mso Schneider:
As requested in our last telephone conversation, I am enclosing
herewith the following:
copy of the new sketch which gives more details than
the original one
o
copy of survey showing the approximate location of
the dock and catwalk
Please note the approximate height above the water grade is
This is ~scheduled for the hearing of April 27, 1989. If there
is anything further you may require prior to that date, please
let me ~OWo
You can call me at the following telephone numbers:
office: 516- 437-1020
home : 718- 468-8427
Very ,~ruly your~,
Eleanor Bastone
encls.
FRANK A. KUJAWSKI, JR., President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
TELEPHONE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
January 6, 1989
Mr. John Holzapfel, Chairman
Southold Town Conservation Advisory Council
Main Road
Southold, New York 11971
Dear Mr. Holzapfel:
Transmitted herewith is application. No. 1-1-89-127-68 for a
Wetland Permit submitted by John and Eleanor Bastone.
Please prepare a written report of findings and
recommendations with respect to this application.
Very truly yours,
F~: j as
Attachment
cc: Bldg. Dep't.
Frank A. Kujawski, Jr.
President
Board of Town Trustees
FRANK A. KUJAWSKI, JR., President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
TELEPHONE
(516) 765-1892
January 6, 1989
Mr. Robert A. Greene
Alternate Regional Permit Administrator
New York State D.E.C.
Bldg. 40, SUNY, Room 219
Stony Brook, New York 11794
Re: Mr. and Mrs John Bastone-App. No. 1-1-89-127-6-8
Dear Mr. Greene:
Please be advised that this office has received a partial
application in the above referenced matter~. Pursuant to the Code
of the Town of Southold, the Board of Town Trustees will not act
upon an application until it is deemed complete by the submission
of documentary proof that all other necessary permits and
approvals have been received.
Please keep this office informed of your progress in this
matter. We wish to be involved in your environmental review
under the S.E.Q.R.A. Legislation.
Feel free to contact this office at (516) 765-1932 should
you have any questions in regard to this matter.
Very truly yours,
Frank A. Kujawski, Jr., Pres.
Board of Town Trustees
FAK: jas
cc: Mr. and Mrs. John Bastone
C.A.C.
Board of Appeals
Building Dep ' t.
Army Corps of Engineers
FRANK A. KUJA~/SKI, JR., President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
TELEPHONE
(516) 765-1892
To Whom It May Concern:
January 6, 1989
Attached hereto is a Short Environmental Assessment Form
submitted by John and Eleanor Bastone for a wetland permit to
construct walkway, floating dock and landing.
Property is located at 1810 Oakwood Drive, Laurel, .N.Y.
., j i, Jr. /~
President
Board of ~,~Town Trustees
Posted: January 6, 1989
FRANK A. KUJAWSKI, JR., President
ALBERT J. KRUPSKI, JR., Vice-President
JOHN M. BREDEMEYER, III
JOHN L. BEDNOSKI, JR.
HENRY P. SMITH
TE LEP H O NE
(516) 765-1892
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
December, 9, 1988
Mr. and Mrs. John Bastone
1810 No. Oakwood Rd.
Laurel, N.Y. 11948
Re: Wetland Application No. 11-88-127-68, property located at 1810
No. Oakwood Dr. Laurel, N.Y.
Dear Mr. and Mrs. Bastone:
On December 8, 1988 the Board of Trustees inspected above
referenced property and it was determined that we need a better
sketch of dock, how far will it go out into the water, etc. We will
need this information by our next meeting on December 15, 1988.
When you come into the office to submit necessary information,
would you please pick up a Public Notice sign to be posted on
property. Thank you.
FAK: jas
Very truly yours,
Frank A. Kujawski
'Board of Trustees
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall, 53095 Main Road
P.O. Box 728
Southold, New York 11971
TELEPHONE
(516) 765-1892
APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF
SOUTHOLD, SUFFOLK COUNTY, NEW YORK FOR THE ISSUANCE OF A PERMIT
PURSUANT TO THE LAWS, ORDINANCES AND REGULATIONS GOVERNING THE
COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS
OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE' OF PERMITS PURSUANT
TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD.
TAX MAP NO..
AGENT
PHONE NO.
f")SIZEOF PROPOSED WORK
~ ~pr/ ................
PERMIT REQUESTED TO w- -
LOCATION OF PROPERTY FOR WHICH PERMIT WANTED
...... _ _
HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION
DEPTH.BELOW LOW WATER
YARDS TO BE EXCAVATED
YARDS TO BE FILLED
WIDTH OF CANAL, CREEK OR BAY FRONTING PROPERTY
DEPTH AT LOW: TIDE
AVERAGE RISE IN TIDE ~~__, ~ ~
DISTANCE TO THE NEAREST CHANNEL FT.
DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE AREA
IS THIS FOR' PRIVATE OR BUSINESS USE? :~ ~
AREA ZONING
FT.
MANNER IN WHICH MATERIAL WILL BE REMOVED OR' DEPOSITED
,NTENDED USE OF pROPERTy 5/ 6Ce '
DESCRIBE ANY KNOWN PRIOR OPERATIONS CONDUCTED ON THE PREMISE
AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN ISSUED TO ERRECT
STRUCTURES OR TO DREDGE OR DEPOSIT FILL ON SAID PREMISES AND WHETHER
ANY PERMITS OR LICENSES WERE EVER SUSPENDED OR REVOKED BY A GOVERNMENTAL
AGENCY
DESCRIBE FULLY THE REHABILITATION AND PROPOSED CONDITION OF THE
PREMISES AFTER THE WORK IS COMPLETED INCLUDE AN ADDITIONAL SURVEY OF
THE PROJECT SITE IF NECESSARY
WRITTEN CONSENT OF THE OWNER OF THE PROPERTY, IF NOT THE SAME AS THE
APPLICANT. ~
ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT WOULD
PROHIBIT THIS PROJECT?
/
/
/
COUNTY OF SUFFOLK
STATE OF NEW YORK
)
)ss:
BEING DULY SWORN DEPOSES
AND SAYS THAT HE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS,
AND THAT ALL STATEMENTS CONTAINED HEI~EIN ARE TRUE T.O THE BEST
OF HIS KNOWLEDGE AND BELIEF, THAT THE WORK WILL BE DONE IN THE
MANNER SET FORTH IN THIS APPLICATION A~D AS MAY BE APPROVED BY
THE TOWN BOARD OF THE TOWN OF SOUTHOLD. THE APPL
HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND
FREE F~OM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY
VIRTUE OF SAID PER~IT, IF ~ANTED.
in completing this application I hereby authorize the Trustees~
agent or representatmve to enter onto my property to inspect the
premises in conjunction wihh revie~~pp~
~[N~D~E SIGNATURE OF APPLICANT
SWORN TO BEFORE ME THIS
DAY OF
NOTARY PUBLIC
EXAM]NED
APPROVED "WETLANDS" PERMIT (CHAPTER 97).
APPROVED "BOAT,DOCKS, WHARVES" PERMIT (CHAPTER 32)
DISAPPROVED "WETLANDS PERMIT" (CHAPTER 97)
DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT (CHAPTER 32)
CONDITIONS, IF ANY
EXAMINING BODY
SIGNATURE OF CHAIRMAN
COMPUTATION OF FEES
Approved 2/27/85
14-16-4 (2/87)--Text 12
"~RbJECT I.D. NUMBER
617.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT
For UNLISTED ACTIONS Only
PART I--PROJECT INFORMATION (To be completed by Applicant or Project spbnsor)
FORM
SEQR
3. PROJECT LOCATION:
Municipality ~'//~ L County '~U F FO/~=-K
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc., or provide map)
, , , ).
5. IS PROPOSED ACTION:
[] New [] Expansion
~Modificationlalteration
s N& s
DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres
Ultimately acres L c-ss f; # t Ae. R C-
8. WILL__~OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
U~Yes [] No If No, describe briefly
9. ',V~,~S PRESENT LAND USE IN VICINITY OF PROJECT?
~ Residential [] !ndustrial [] Commercial
Describe:
[] Agriculture [] Park/Forest/Open space [] Other
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,
STATE Q_?I LOCAL)?
[] Yes [] No If yes, list agency(s) and permit/approvals _
11. DOES ANY ASr_~ OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
[] Yes I__~No ~f yes, list agency name and permit/approval
12. AS a RESULT ~/FROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
[] Yes ~ No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE tS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name:
Date:
Signature:
J 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
1
~ view
A. DOES ACTION EXCEED ANY TYPE ~"~RESHOLD IN 6 NYCRR, PART 617.127 If yes, coordinate the re ' process and use the FU. LL'B~.~.
[] Yes [] No
B. 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 cuality, surface or-greundwater quality or quantity, noise levels,' existing traffic patterns, solid waste production or
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:
C3. 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 briefl
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 C1-C57 Explain briefly.
C7. Other impacts (ihbl~ding changes in use of either quantity or type of energy)? Explain briefly.
D. IS THERE, OR I~,~F-.F{E LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
[] Yes ~ No If Yes, explain briefly
PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine 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 delail to show that all relevant adverse im pacts 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 ot Responsible Officer m Lead Agency
Signature of F~espons~bJe Officer m Lead Agency
Title of Responsible Officer
Date
Signature of Preparer (If different from responsible officer) .
2
14~165~2 (2/87)-- 7c
617.21
Appendix A
State Environmental Quality Review
FULL ENVIRONMENTAL ASSESSMENT FORM
SEQR
Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, Whether a project
or action may be significant. The question of whether an action may be significant is not always easy to answer. Frequent-
ly, there are aspects of .a project that are subjective or unmeasureable. It is also understood that those who determine
significance may have little or no formal knowledge of the environment or may be technically_ e.xpert in environmental
analysis. In addition, many who have knowledge in one particular area may ~n/ot be awareof the broader concerns affecting
the question of significance. /
The full EAF is intended to provide a method whereby applicants ~f~ agencies can be assured that the determination
process has been orderly comprehensive in na~. et flexible to a~,~ntrod~ction of information to fit a project or action.
Full EAF Components: The full EAF is comprisedof~,~ree pa.~ .
Part 1: Provides objective data and i_nf'ormationX~bou/t a given project and its site. By identifying basic project
data, it assists a reviewer in the analysis t~(~/t~kes place in Parts 2 anal 3. ·
Part 2:' Focuses on identifying the range of possibl/i~h~acts th~at may occur from a project or ~ct'ion. It provides
guidance as to whether an impact is likely/t'o be c~nsid~'red small to moderate or whether it is a potentially-
large impact. The form also identifies/~ether an~,~act can be mitigated or reduced.
Par't 3: If any impact in Part 2 is identified as potentially-large,"~n Part 3 is used to evaluate whether or not the
impact is actually imPortant. '. '
DETERMINATION OF SIGNIFICANCE--Type I and Unlisted Actions
Identify the Portions~of EAF completed for this project: [] Part I [] Part 2 I-lPart 3
Upon review of the informatio~ recorded on this EAF (Parts 1 and 2 and 3 if appropriate), and any other supporting
information, and considering both the magitude and importance of each impact, it is reasonably determined by the
lead agency that:
[] A. The project will not result in any large and important impact(s) and, therefore, is one which ~viil not
have a significant impact on the environment, therefore a negative declaration will be prepared.
[] B. Although the project could have a significant effect on the environment, there will ~ot be a significant
......... eff~ect for this Unlisted Action because the mitigation measures described in PART 3 have been required,
therefore a CONDITIONED negative declaration will be prepared.*
[] C. The project may result in one or more large and important impacts that may have a significant impact
on the environment, therefore a positive declaration will be prepared.
* A Conditioned Negative Declaration is onty valid for Unlisted Actions
Name of Action
Name of Lead Agency
Print or Type Name of Responsible Officer in Lead Agency
Signature of Responsible Officer in Lead Agency
Title of Responsible Officer
Signature of Preparer ( f different from responsible officer)
Date
~'~' PART 1--PROJECT INFORr~ATION
Prepared by ProjeCt Sponsor
NOTICE: This document is designed to assist in determining whether the action proposed may have a significant effe(
on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considere
as part of the application for approval and may be subject to further verification and public review. Provide any addition~
information you believe will be needed to complete Parts 2 and 3. ._
It is expected that completion of the full EAF will be dependent on information currently available 'and will not involv
new studies, research or investigation. If information requiring such additidnal work is unavailable, so indicate and specif
each instance.
NAME OF ACTION
LOCATION OF ACTION (Include Street Address, Municipality and County)
NAME OF APPLICANT/SPONSOR I BUSINESS TELEPHONE
I
( )
ADDRESS
CITY/PO .~ STATE I ZIP CODE
NAME OF OWNER (If different)
ADDRESS
BUSINESS TELEPHONE
( )
CITY/PO
STATE I ZIP CODE
DESCRIPTION OF ACTION
Please Complete Each Question-Indicate N.A. if not applicable
A. 'Site Description
Physical setting .of overall project, both developed and undeveloped areas.
1. Present land use: I-IUrban il. Industrial E3Commercial ilResidential (suburban) I-'lRural (non-farrr
l-lForest i-t ~Agriculture ilOther
2. Total acreage of p~oject area: acres.
APPROXIMATE ACREAGE 'PRESENTLY AFTER COMPLETION
Meadow or Brushland (Non-agricultural) acres acres
Forested acres acres
Agricultural (Includes orchards, cropland, pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres
Water Surface Area acres acres
Unvegetated (Rock, earth or fill) acres acres
Roads, buildings and other paved surfaces acres : acres
Other (Indicate type) acres acres
3. What is predominant soil type(s) on project site?
a Soil drainage: F1Well drained % of site [-]Modbrately well drained % of site
~Poorly drained % of site
b. If any agricultural land is involved, how many acres of soil are classified within soil group I through 4 of the NY~
Land Classification System? acres. (See 1 NYCRR 370).
4. Are there bedrock outcroppings_on project site? l-lYes [-]No _
a. What is depth-to bedrock? (in feet)
2
5. 'A~proximate percentage of p,,~,posed project site With slopes: 1-10-J0S.~.~ % Z/10-15% %
I--[15% or greater %
6. Is project substantially contiguous to, or contain a building, site, or district, listed on the State or the National
Registers of H storic Places? E~Yes r-]No
7. Is project substantially contiguous to a~site listed on the Register of National Natural Landmarks? [Yes r-iNo
8. What is the depth of the water table? (in feet) -.
9. Is site located over a primary, principal, or sole source aquifer? r-lYes l-lNo
10. Do hunting, fishing or ~hell fishing opportunities presently exist in the project area? []Yes I-1No
11. Does project site contain any species of plant or an'imal life that is identified as threatened or endangered?
I-Wes [-]No According to
Identify each species
12. Are there any unique or unusual land forms on the project site? (i.e., cliffs, dunes, other geological formations)
Z/Yes i-qNo Describe
13. Is the project site presently used by the community or neighborhood as an open space or 'recreation area?
I-lYes i-lNo If yes, explain
14. Does the present site include scenic views known to be important to the community~
l-lYes I-INo '
15. Streams within or contiguous to project area:
a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland areas within or contiguous to project area:
a. Name b. Size (In acres)
17: Is the site served by~xisting public utilities? E]Yes Z/No
a) If Yes, does sufficient cap~acity exist to allow connection? [Yes [~No
b) If Yes, will improvements be necessary to allow connection? []Yes E3No
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, AYticle 25-AA,
Section 303 and 304? I-lYes I-iNo
19. Is tt~e site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8
of the ECL, and 6 NYCRR 6177 E3Yes l--INo
20. Has the site ever been used for the disposal of solid or hazardous wastes? l-lYes I-1No
B. Project Description
1. Physical dimensions and scale of project (fill in dimensions as appropriate)
a. Total contiguous acreage owned or controlled by project sponsor
b. Project acreage to be deYeJoped: acres initially;
c. Project acreage to remain undeveloped acres.
d. Length of project, in miles: (If appropriate)
e. If the project is an expansion, indicate percent of expansion proposed %;
f. Number of off-street parking spaces existing ; proposed
g. Maximum vehicular trips generated .~er hour (upon completion of project)?
h. If residential: Number and type of housing units:
One Family Two Family Multiple Family
Initially
Ultimately
· Dimensions: (in feet)' of largest proposed structure height; width;
j. Linear feet of f~.ontage along a public thoroughfare project will occupy ii? ft.
acres·
acres ultimately.
Condominium
. length.
2. How much natural materia~.e., rock, earth,, etc.) will be removed fr he site?
3. Will disturbed areas be reclaimed? I-lYes [:]No i-IN/A
a. If yes, for what intend~c~ purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? I-lYes I-iNo
c. Will upper subsoil be stockpiled for reclamation? []Yes I-INo
4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? acres.
5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
[:]Yes F-INo ' '
6. :If single phase project: Anticipated period of construction
7. If multi-phased:
a. Total number of phases anticipated
b. Anticipated date of commencement phase 1
c. Approximate completion date of final phase
d. Is phase I functionally dependent on subsequent phases?
8. Will blasting occur during construction? i-lYes l-INo
9. Number of jobs generated: during construction
10. Number of jobs eliminated by this project
11. Will project require relocation of any p~ojects or facilities?
(number).
months, (including demolition).
tons/c~bi'c ,yards
month
month . year:
I-lYes
; after project is complete
year, (including demolitioni.
r-lYes -1No If yes, explain
12. Is surface liquid waste disposal 'involved? I-lYes l-INo
a. If yes, indicate type of waste (sewage, industrial, etc.) and amount
b. Name of water body into Which effluent will be discharged
13. Is subsurface liquid waste disposal involved? I-lYes []No Type
14. Will surface area of an existing water body increase or decrease by proposal?
Explain
E3Yes I-1No
15,
16.
Is project or any portion of project located in a 100 year flood plain? I--lYes
Will the project generate solid waste? I-lYes []No
a. If yes, what is the amount per month tons
b. If yes, will-an existing solid waste facility be used? I-lYes I-INo
c. If yes, give name ; location
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill?
e. If Yes, explain
I-1No
r-lYes I-INo
17.
18.
19.
20.
21.
Will the project involve the disposal of solid waste? [:]Yes
a. If yes, what is the anticipated rate of disposal?
b. f yes, what is the anticipated site life? years.
Will project use herbicides or pesticides? l-lYes 71No
l-INo
tons/month.
Will project routinely produce odors (more than one hour per day)? I-lYes
Will project produce operating noise exceeding the local ambient noise levels?
Will project result in an increase in energy use? [-]Yes [:]No
If yes , indicate type(s)
22. If water supply is from wells, indicate pumping capacity
23. Total anticipated water usage per day gallons/day.
24. Does project'involve Local, State or Federal funding? []Yes
If Yes, explain
F-1No
E]Yes
I-lNo
gallons/minute.
r-lNo
4
252t.Approvals Required:
Type
Submittal
Date
City, Town, Village Board l-lYes t-INo
City, Town, Village Planning Board I-lYes f-iNo
City, Town Zoning Board l-lYes I-INo
City, County Health Department I-lYes I-INo
Other Local Agencies I-lYes i-lNo
Other RegionalAgencies f-lYes I-INo
State Agencies I-lYes I-1No
Federal Agencies I-IYes i-lNo
C. Zoning and Planning Information
1. Does proposed action involve a planning or zoning decision? r-lYes CINo
If Yes, indicate decision required:
r-lzoning amendment I--Izoning variance i-lspecial use permit [-Isubdivision r-lsite plan
r-lnew/revision of master plan E3resource management plan r--iother
2. What is the zoning classification(s)of the site?
3. What is the maximum potential development of the site if developed as permitted by the present zoning?
4. WHat is the proposed zoni6g of the site?
· 5. What is the.maximum potential development of the site if developed as permitted by the proposed zoning?
6. Is the proposed action consistent with the recommended uses in adopted local land use plans? I-lYes I-1No
7. What are the predominant land use(s) and zoning classifications within a ~¼ mile radius of proposed action?
8. Is the proposed action compatible with adjoining/surrounding land uses within a ~,4 mile? t-lYes []No
9. If the proposed action is the subdivision of land, how many lots are proposed?
a. What"is the minimum lot size proposed?
10. Will proposed action require any authorization(s} for the formation of sewer or water districts? r-]Yes Fl-]No
11. Will the proposed action create a demand for any community provided services (recreation, education, police,
fire protection)? I--lYes [] No
a. If yes, is existing capacity sufficient to handle projected demand? r-lYes F-INo
12. Will the proposed action result in the generation of traffic significantly above present levels? []Yes Fl-]No
a. If yes, is the existing road network adequate to handle the additional traffic? i-lYes []No
D. Informational Details
Attach any additional information as may be-needed to clarify your project. If there are or may be any adverse
impacts associated with your proposal, please discuss such impacts and the measures which ybu propose to mitigate or
avoid them
E. Verification
I certify that-the information provided above is true to the best of my knowledge.
Applicant/Sponsor Name Date
Signature . :_. litle
If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding
with this assessment, r , ......
5
Par~PROJECT IMPACTS AND TH~ MAGNITUDE
Responsibility .of Lead Agency
General Information (Read Carefully)
· In completing the form the reviewer should be guided by the question: Have my responses and determinations been
reasonable? '[;he reviewer is not expected to be an expert environmental analyst.
· Identifying that an impact will be potentially large (column 2) does not mean that it is also necessarily significant.
Any large impact must be evaluated in PART 3 to determine significance, identifying an impact in column 2 simply
asks that it be looked at further.
· The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of
magnitude that would trigger a response in column 2. The examples are generally applicable'tl~'roughout the State ann
for most situations. But, for any specific project or site other examples and/or lower thresholds may be appropriate
for a Potential Large Impact response, thus requiring evaluation in Part 3.
· The impacts of each project, on each site,,in each locality, will vary. Therefore, the examples are illustrative 'and
have been offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to answer each question.
· The number of examples per question does not indicate the importance of each question.
· In identifying impacts, consider long term, short term and cumlative effects. ~ ~
Instructions (Read carefully) ' ·
a. Answer each of the 19 questions in PART '2. Answer Yes if ther(~will be any impact.
b. Maybe answers should be considered as Yes answers.
c. If answering Yes to a question then check the appropriate box (column 1 or 2) to indicate the potential size of the
impact. If impact threshold equals or exceeds any example provided, check column 2. If impact will occur but threshold
is lower than example,r check column 1.
d. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3.
e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a Small to moderate
impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This
must be explained in Part 3.
IMPACT ON LAND
1 Will the proposed action result in a physical change to the project site?
[]]NO F-lYES
Examples that would apply to column 2
· Any construction on slopes of 15% or greater, (15 foot rise per 100
foot of length}, or where the general slopes in the project area exceed
10%.
· Construction on land where the depth to the water table is less than
3 feet.
· Construction of paved parking area for 1,000 or more vehicles.
· Construction on land where bedrock is exposed or generally within
3 feet of existing ground surface.
· Construction that will continue for more than 1 year or involve more
than one phase or stage.
· Excavation for mining purposes that would remove more than 1,000
tons of natural material (i.e., rock or soil) per year.
· Construction or expansion of a sanitary landfill.
· Construction in a designated floodway.
· Other impacts
2. Will there be an effect t.'. .... ,y ur, que or unusual land forms found on
the site? (i.e., cliffs, dunes, geological formations, etc.)F-1NO E3YES
· Specific land forms:
6
I 2 ~3
Small to Potential Can impact Be
Moderate Large Mitigated By
Impact Impact Project .Change
[] [] I-qYes I--INo
[] [] i-lYes I'-]No
L--] [] I-lYes I-]No
[] [] [--]Yes I-]No
' [] [] []Yes []No
[] [] []Yes []No
[] [] ~" [--]Yes []No
[] [] []Yes []No
[]- [] []Yes []No
[] [] []Yes []No
IMPACT ON WATER
3. Will proposed action affect any water body designated as protected?
{Under Articles 1.5, 24, 25 of the Environmental Conservation Law, ECL)
[NO I~YES
Examples that would apply to column 2
· Developable area of site contains a protected water body.
· Dredging more than 100 cubic yards of material from channel of a
protected stream.
· Exten sion of utility distribution facilities through a protected water body.
· Construction in a designated freshwater or tidal wetland.
· Other impacts:
4. Will proposed action affect any non-protected existing or new body
of water? I-]NO E:]YES
Examples that would apply to column 2
· A 10% increase or decrease in the surface area of any body of water
or more than a 10 acre increase or decrease.
· Construction of a body of water that exceeds 10 acres of surface area.
· Other impacts:
5. Wil.I Proposed Action affect surface or groundwater
quality or quantity? r-]NO []YES
Examples that would apply to column 2
· Proposed Action will_require a discharge permit.
· Proposed Action requires use of a source of water that does not
have approval to serve proposed (project) action.
· Proposed Action requires water supply from wells with greater than 45
gallons per minute pumping capacity.
· Construction or operation causing any contamination of a water
supply system.
· Proposed Action will adversely affect groundwater.
· Liquid effluent will be conveyed off the site to facilities which presently
do not exist or have inadequate capacity.
· Proposed Action would use water i~' excess of 20,000 gallons per
day.
· Proposed Action will likely cause siltation or other discharge into an
existing body of water to the extent that there will be an obvious visual
contrast to natural conditions.
· Proposed Action will require the storage of petroleum or chemical
products greater than !,100 gallons.
· Proposed Action will allow residential uses in areas without water
and/or sewer services.
· Proposed Action locates commercial and/or industrial uses which may
require new or expansion of existing waste treatment and/or storage
facilities.
· Other impacts:
6. Will proposed action alter drainage flow or patterns, or surface
water runoff? I-]NO EYES
Examples that Would apply to column 2
· Proposed Action would change flood water-flows.
..... ' I 2 3 '
Small to Potential Can Impact Be
Moderate Large Mitigated By
Impact Impact Project Change
'" [] [] []yes []No
[] [] : I--lYes E~]No
[] [] i-]Yes []No
[] [] I-'lYes .I-1No
[] [] ~ I-lYes · [-INo
[] [] I-Ives ,I-1No
[] [] [-']Yes 'l--INo
[] [] []Yes i--INo
[] [] I-lYes I--1No
[] [] []Yes I-[No
[] [] I-lYes '[]No
[] [] []Yes I--INo
[] [] [-]Yes i-]No
[] [] I--[Yes .J?lNo
[] [] r-'lyes-
[] [] I-lYes E3No
[] [] E3Yes- . []No
[] [] [-'[Yes []No
[] ..- E3~ I-IVes I-1No
[] [] []Yes E3No
.... [] ; [] F"]Yes l-lNo
· Proposed Action may cause substantial erosion.
· Proposed Action is incompatible with existing drainage patterns.
· Proposed Action will allow development in a designated floodway.
· Other impacts:
IMPACT ON AIR
7. Will proposed action affect air quality? r-lNO I-lYES
Examples that would apply to column 2
· Proposed Action will induce 1,000 or more vehicle trips in any given
hour.
· Proposed Action will result in the incineration of' more'than 1 ton of
refuse per hour. ..
· Emission rate of total contaminants will exceed 5 lbs. per hour or a
heat source producing more than 10 million BTU's per hour.'
· Proposed action will allow an increase in the amount of land committed
to industrial use.
· Proposed action will allow an increase in the density of industrial
development within existing industrial areas.
· Other impacts:
IMPACT ON PLANTS AND ANIMALS
8. Will Proposed Action affect any threatened or endangered
species? ENO r-lYES
Examples that would apply to column 2
· Reduction of one or more species listed on the New York or Federal
list, using the site, over or near site or found on the site.
· Removal of any portion of a critical or significant wildlife habitat.
· Application of pesticide or herbicide more than twice a year, other
than for agricultural purposes.
· Other impacts:
9. Will Proposed Action substantially affect non-threatened or
non-endangered species? []]NO EYES
Examples that would apply to column 2
· Proposed Action would substantially interfere with any resident or
migratory fish, shellfish or wildlife species.
· Proposed Action requires the removal of more than 10 acres
of mature forest (over 100 years of age) or other locally important
vegetation.
IMPACT ON AGRICULTURAL LAND RESOURCES
10. Will the Proposed Action affect agricultural land resources?
FqNO E]YES
Examples that would apply to column 2
· The proposed action would sever, cross or limit access to agricultural
land (includes cropland, hayfields; pasture, vineyard, orchard, etc.)
Small to Potential Can
Moderate Large ~Mitigated By
Impact Impact Project-Change
[] [] I-lYes I-]No
~J--J . [] []Yes r-iN0
. [] [] l--JYes ,[]No.
[] []- []Yes ENo
j [] [] . r-lyes I-INo
[] [] ' [-7lYes "[]No
[] [] r-]Yes F-JNo
[] [] []Yes I--INo
[] [] ' []Yes []No
[] [] r-lYes []No
[] , [] I-lYes I-]No
[] [] r-lyes tDNo
[] [] []Yes
[] [] I-lYes I-qNo
1
[] [] []Yes l-lNo
[] [] J--JYes J:'lNo '
· Construction activity would excavate or compact the soil profile of
agricultural land.
· The proposed action would irreversibly convert more than 10 acres
of agricuJtural land or, if located in an Agricultutal District, more
than 2.5 acres of agricultural land.
· The proposed action would disrupt or prevent installation of agricultural
land management systems (e.g., subsurface drain lines,, outlet ditches,
strip cropping); or create a need for such measures (e.g. cause a farm
field to drain poorly due to increased runoff)
· Other impacts:
IMPACT ON AESTHETIC RESOURCES
11. Will proposed action affect aesthetic resources?
[]NO [YES
(If necessary, use the Visual EAF Addendum in Section 617.21,
Appendix B.)
Examples that would apply to column 2
· Proposed land uses, or project components obviously different from
or in sharp contrast to current surrounding land use patterns, whether
man-made or natural.
· Proposed land uses, or project components visible to users of
aesthetic resources-which will eliminate· or significantly reduce their
enjoyment of the aesthetic qualities of that resource.
· Project components that Will result in the elimination or significant
screening of scenic views known to be important to the area.
· Other Impacts:
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
12. Will Proposed Action impact any site or structure of historic, pre-
historic or paleontological importance? I--]NO I-lYES
Examples that would apply to column 2
· Proposed Action occurring wholly or partially within or substantially
contiguous to any facility or site listed on the State or National Register
of historic places.
· Any ~mpact to an archaeological site or fossil bed located within the
project site.
· Proposed Action will occur in an area designated as sensitive for
archaeological sites on the NYS Site Inventory.
· Other impacts:
IMPACT ON OPEN SPACE AND RECREATION
13. Will Proposed Action affect the quantity or quality of existing or
future Qpen spaces or recreational opportunities?
Examples that would apply to column 2 [-]NO [:]YES
· The permanent foreclosure of a future recreational opportunity.
· A major reduction of an open space important to the community.
· Other impacts:
9
I 2 - 3 '~.
Small to ~ Potential Can ImpaCt Be
Moderate Large Mitigated By
Impact Impact Project Change
[] [] []Yes []No
· r-I [] []Yes I--JNo
[] [] []Yes [-]No
[] I--I. []Yes []No
[] [] f-lYes []No
[] [] []Yes []No
[] [] I-lYes []No
[] [] []Yes []No
[] [] [-']Yes []No
[] [--1~ [] Yes . . [] No
[] [] [--[Yes []No
[] [] l--lYes []No
[] [] [-]Yes ~F-INo
[] [] [-]Yes []No
[] [] · I-lYes l--INo
IMPACT ON TRANSPORTATION
14. Will there be an effect to existing transportation systems?
FqNO E]YES
Examples that would apply to column 2
· Alteration of present patterns of movement of people and/or goods.
· Proposed Action will result in major traffic problems.
· Other impacts:
IMPACT ON ENERGY
15. Will proposed action affect the community's sources of fuel .or
energy supply? I-ENO I-lYES
Examples that would apply to column 2
· Proposed Action will cause a greater than 5% increase in the use of
any form of energy in the municipality.
· Proposed Action will require the creation or extension of an energy
transmission or supply system to serve more than 50 single or two family
residences or to serve a major commercial or industrial use.
· Other impacts:
NOISE AND ODOR IMPACTS
16. Will there be objectionable odors, noise, or vibration as a result
of the Proposed Action? I-qNO I-lYES
Examples that would apply to column 2
· Blasting within 1,500 feet of a hospital, school or other sensitive
facility.
· Odors will occur routinely (more than one hour per day).
· Proposed Action will produce operating noise exceeding the local
ambient noise levels for noise outside of structures.
· Pr'0posed Action will remove natural barriers that would act as a
noise screen.
· Other impacts:
IMPACT ON PUBLIC HEALTH
17. Will Proposed Action affect public health and safety?
E:]NO E:]YES
Examples that would apply to column 2
· Proposed Action may cause a risk of explosion or release of hazardous
substances (i.e. oil, pesticides, chemicals, radiation, etc.) in the event of
accident or upset conditions, or there may be a chronic Iow level
discharge or emission.
· Proposed Action may result in the burial of "hazardous wastes" in any
form (i.e. toxic, poisonous, highly reactive, .radioactive, irritating,
infecti:ous, etc.)
· Storage facilities for one million or more gallons of liquified natural
gas or other flammable liquids.
· Proposed action-may result in the excavation or other disturbance
within 2,000 feet of a site used for the disposal of solid or hazardous
waste,
· Other impacts:
10
Small to Potential Can Imp~.Ct Be
Moderate Large Mitigated By
Impact Impact Project Chang~
~ [] [] i-lYes "F-INo
, [] [] r-lYes '[-1NO
[] ' 'E~ I-lYes I-]NO,
[] '[] []Yes · ID~O
[] : [] []Yes J-'IN~
[] [], I-lyes []No
[] [] [-~Yes J-]No
[] [] []Yes J--JNo
[] [] J--JYes J-]No
[] [] []Yes []No
[] [] : []Yes J-JNo
[] [] J-qYes-.. J--JNo
[] . J~]~ []Yes []No
[] [] []Yes []No
[] [] []Yes []NO
-'-[-'] , [] []Yes FT]No
IMPACT ON GROWTH AND CHARACTER
OF COMMUNITY OR NEIGHBORHOOD
18. Will proposed action affect the character of the existing community?
[]NO E~YES
Examples that would aPply to column 2
· The permanent population of the city, town or village in which the
project is located .is likely to grow by more than 5%.
· The municipal budget for capital expenditures or operating services
will increase by more than 5% per year as a result of this project.
· Proposed action will conflict with officially adopted plans or goals.
· Proposed action will cause a change in the density of land use.
· Proposed Action will replace or eliminate existing facilities, structures.
or areas of historic importance to the community.
· Development will create a demand for additional community services
(e.g. schools, police and fire, etc.)
· Proposed Action will set an important precedent for future projects.
· Proposed Action will create or eliminate employment.-
' Other impacts:
I 2 3
Small to Potential Can Impact Be
Moderate L~rge Mitigated By
Impact ImpaCt !Project Change
[] [] l--lYes [--]No
[] [] ' [-]Yes i-[No
[] [] r-]Yes i--[No
[] [] []Yes [-1No
[] ~ I-']' []Yes I--1No
[] [] ' i-lYes [-INo
[] [] []Yes I--INo
[] [] I-lYes [-INo
19. Is there, or is there likely to be, public controversy related to
potential adverse environmental impacts? II, NO I-lYES
If Any Action in Part 2 Is Identified as a Potential Large Impact or
If You Cannot Determine the Magnitude of Impact, Proceed to Part 3
Part 3--EVALUATION OF THE IMPORTANCE OF iI"VlPACTS
-.- Responsibility of Lead Agency.:.
Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be
mitigated.
Instructions
Discuss the following for each impact identified in Column 2 of Part 2:
1. Briefly describe the impact.
2. Describe (if applicable) how the impact could be mitigated or reduced to a small to moderate impact by projectehange(s).
3. Based on the information available, decide if it is reasonable to conclude that this impact is important.
To answer the question of importance, consider: · The probability of the impact occurring
· The duration of the impact
· Its irreversibility, including permanently lost resources of value
· Whether the impact can or will be controlled -"
· The regional consequence of the impact
· Its potential divergence from local needs and goals
· Whether known objectIons to the project relate to this ~mpact.
(Continue on attachments)
11
Appendix B
State Er vironmental QUality Review
V sual EAF Addendum
This form may be' used to provide additional information relating to Question 1 1 of Part 2 of
the Full EAF.
Visibility
1. Would the project be visible from:
· A parcel of land which is dedicated to and available
to the public for the use, enjoyment and appreciation
of natural or man-made scenic qualities?
· An overlook or parcel of land dedicated to public [] F-]~ [] [] []
observation, enjoyment and appreciation of natural
or man-made scenic qualities? ...
· A site or structure listed on the National or State [] [] [] [] []
Registers of Historic Places?
· State Parks? [] [] [] [] []
· The State Forest Preserve? [] [] [] [] []
· National Wildlife Refuges and state game refuges? [] [] [] [] []
· National Natural Landmarks and other outstanding [] [] [] [] []
natural features? -
· National Park. Ser~zi~e lands? [] [] [] [] []
· Rivers designated as National or State Wild, Scenic [] [] [] [] []
or Recreational?
(To be completed by Lead Agency)
Distance Between
Project and Resource (in ~Miles)
0-1/4 1/4 - 1/z I/2-3 3-5 5 +
· Any transportation corridor of high exposure, such [] [] - [] [] []
as part of the Interstate System, or Amtrak?
· A governmentally established or designated interstate [] [] [] [] []
or inter-county foot trail, or one formally proposed for
establishment or designation?
· A site, area, lake, reservoir or highway designated as [] [] [] [] []
scenic?
· Municipal park, or designated open space?
· County road? -~
· State?
· Local road?
Is the visibility of the p~oject seasonal? (i.e., screened by summer foliage, b~t visible during other
seasons)
[]Yes []No
3. Are any of the resources checked in question I used by the public during the rime'of year
during which the project will be visible?
.[~ Yes [] No-
OF EXISTING VISUAL ENVIRONMENT
4. From each item checked in question 1, check those which generally describe the surrounding
environment.
Within
'1/4 mile * 1 mile
Essentially undeveloped [] []
Forested [] []
Agricultural [] []
Suburban residential [] []
Industrial [] []
Commercial [] []
Urban [] []
River, Lake, Pond [] []
Cliffs, Overlooks [] []
Designated Open Space [] E~]'
Flat - ~~ [] []
Hilly [] []
Mountainous [] []
Other [] []
NOTE: add attachments as needed
5. Are there visually similar projects within:
'1/2 mile []Yes []No
*1 miles []Yes []No
*2 miles -E~Yes [] No
*3 miles []Yes []No
* Distance from project site are provided for assistance. Substitute other distances as appropriate
EXPOSU RE
6. The annual number of viewers likely to observe the proposed project is
NOTE: When user data is unavailable or unknown, use best estimate.
CONTEXT
7. The situation or activity in which the viewers are engaged while ~iewing the proposed action is
FREQUENCY
Holidays/
Activity Daily Weekly Weekends Seasonally
Travel to and from work [] [] [] []
Involved in recreational activities [] [] [-- []
Routine travel by residents [] [] [] []
At a residence [] [] [] ~[]
At worksite [] [] [] []
Other [] [] [] []
2
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'ORN TO THE STAND~JIOS O1' THE SUFPQLK COUNTY DEPARTMENT
TH IERV ICES.
SURVEY FOR
JOHN BA$1'ONE
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TOWN OF SOUI'HOLO
ELEANOR BAS TONE
'SUFFOLK COUNTY, NEW YORK
· ~I~UNAUTHORIZED ALTERATION OR AOOITION TO THIS
· *'SURVEY BA VIO~ATiOH ~ SECTION T~OII Q~ THE
NEW YORK STATE EDUCATION LAW
~ COPIEE ~ THIJ SURVEY NOT ~JEARIHD THE LAND
SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL
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NGUARAHTEEI INDICATED HEREON SHJU_L RUN ~'ILY 1~
THE PERSOH FOR WHOM THE SURVEY IS PREPARED
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_TO ADOITIOHAL INSTITUTIOtlS OR SUBSEQUENT
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R DISTANCES SHOWN ,HEREON FROM PROPERTY UHES
TO EXISTINIi STRUCJURES ARE FOR A SPECIFIC
PURPOSE AN0 ARE HOT TO lie USED TO ESTABLISH
PROPERTY LINES OR FOR THE ERECTION OF FENCES
YOUNG e, YOUNG
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AND LAND SURVEYOR N.Y.$. UCENSE NO. IZl145
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