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Home My WebLink AboutHOMAN, JAMESAlbert J. Kmpski, President Johu Holzapfel. Vice President Jim King Martin H. Garrell Peter Wenczel Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 Telephone (5t6) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 24, 1996 Fred Milner $70 Bray Ave. Laurel, NY 11948 RE: James Homart SCTM $1t1-t-14 Dear Mr. Milner: The following action was taken by the Southold Town Board Trustees October 23, 1996: RESOLVED that. the Southotd. Town Boar~ of Trustees approve a waiver to construct a~5'6" X 1t' addition on existing deck. This approval does not constitute any other approvals from any other agencies. If you have any questions, please do not hesitate to contact this office. Albert J. Krupski, Jr. President, Board of Trustees AJK: jmd HENRY P. SMITH, President JOHN M. BREDEMEYER. Vice-Pres. PHILLIP J. GOUBEAUD ALBERT KRUPSKI, JR. ELLEN M. LARSEN BOARD OF TOWN TRUSTEES TOWN OF SOLq'HOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 T~LEPHONE (516) 765-1692 July 28, 1987 Wm. M. Beebe Builder's, Inc. Contractor & Builder New Suffolk Lane Cutchogue, New York 11935 Re: James Homart, Haywaters Road, Nassau Pt., Gutchogue Dear Mr. Beebe: The following action was taken by the Board of Town Trustees during their regular meeting held on July 27, 1987 regarding the above matter. WHEREAS, the Board members have personally vmwed and are familiar with the premises in question and the surrou~diug area, and WHEREAS, the Board considered all the documentation submitted concerning this request, and WHEREAS, the Board made the following findings of fact: 1. By this request appellant requests permission to construct a 10' x 12~ extension to an existing residence. 2. The property is located on Haywaters Road, Nassau Pt., Cutchogue. 3, The project will not affect the health, safety or general welfare of the people of the Town, NOW, THEREFORE BE IT RESOLVED that Wm. M. Beebe Builder's, Inc. on behalf of James Homart BE AND HEREBY IS GRANTED A WAIVER OF THE WETLAND ORDINANCE as aforementioned and all in accordance with the plan submitted with the application dated July 21, 1987. Please be advised that there is a $25.00 fee for the waiver which is now due and payable. Very truly yours, Board of Town Trustees k. Greene, D.E.C., Stony Brook loner Henry G. Williams, D.E.C., Albany Board of Town Trustees - Page James Homan Stephen Mars, Army Corps of Engineers Thomas Hart, Coastal Management Conservation Advisory Council Bldg. Dept. Board of Appeals File PLEASE RETURN TO THE BUiLDiNG DEPT. FOR A DETERMINATIQN ON THE NEED OF ANY OTHER TOWN PERMITS THAT MAY BE REQUIRED FOR THIS PROJECT. CONTRACTOR & BUILDER NEW SUFFOLK LANE CUTCHOGUE, L.I., N.Y. 11935 July 2l, 1987' 516/734-6681 To the Board of To~m Trustees, I request, on behalf of James Homart, a waiver of the wetland of addition to an existing dwelling on the property on H~ywaters Road, Nassau Point, To~n of Southold, N.Y. Wm. ~. Beebe~ Builder Telephone <$I6) 765-1801 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL Town Hall. 53095 Main Road P.O. Box 1179 Southold, New York 11971 The following recommendation was made at the OCTOBER the Southold Town Conservation Advisory Council: 17, 1996 meeting of WR-53 Moved by Robert Keith, seconded by Betty Wells, it was RESOLVED to recommend to the Southold Town Board of Trustees Ai~PROVAL of the Waiver Request of JAMES HOMAN 111-1-1~, to construct a 5~6' x 11' addition on existing deck that is supported by pilings and girder system. 430 Private Road, Fishermans Beach, Cutchogue Vote of Council: Ayes: All Motion carried. Albert J. Kmpski. President John HolzapfeL Vice President Jim King Martin H. Garrell Peter Wenczel Town Hall 53095 Main Road P.O. Box 1179 Sourhold. New York i 1971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Appticatic~ Wetland Permit Application Grandfather Permit Application ~aiver/Amendmen~/Changes L--l~eceived ~pplication. -~eived Fee:$ Complete~ Application Incomplete SEQRA Classification: Type I Type II Unlisted Coor~i~t~on:(d~te sen~) ~CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical .Review: Public Hearin9 Held: Resolution: Name of Applicant Address -~ ~_/' ~_ :~1 ~ Phone Number: ( ~ ) Suffolk County Tax Map Number: Property Location: '.~5~0 (provide LILCO ~, distance ( If applicsLble) to cross streets, and location) FAX%: ,~ard of Trustees Applicati~,~ GENERAL DATA Land Area (in square feet): ~ Area Zoning: ~-'~'~ ~ ~ ~ ~/(1_%'/'A.-~ Previous use of property: ~['~b~ 11Iooo 5~ lr~- Prior permits/approvals __ Agency_ . for site improvements: No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ~ No__ Yes If yes, provide explanation: Project Descrlption (use atsacbznents if necessary) '-" ~rd of Trustees Applicati~ WETLANDJTRUSTEE LANDS APPLICATION DATA ?urpose of the proposed operations: ~O Area of wetlands on lot: square Percent coverage of lot: --- % Closest distance between nearest existing structure and upland edge of wetlands: [ OO ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ I feet Does the pro~ct involve excavation or filling? No Yes ~/0~f. cubic yards cubic yards If yes, how much material will be excavated? How much material will be filled? ~j~. Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if ~ny, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): Board of Trustees Application AUTHORIZATION (where the appilcant is not (print owner oS property) the owner) residing at~i/~C (~Ailing address) do hereby authorize -'~/~ (.Agent) to apply for permit(~Q from the Southoid Board of Town Trustees on my behalf. ~(Owner's signature) BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 ~[ELEPHONE ~516) 765-1892 APPLICATION lB HEREBY MADE TO THE TOWN TRUSTEE~' OF THE TOWN OF APPLICATION NO. DATE OF ^PPLICATI TAX MAP NO. PHONE NO, HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION CREEK, BAY OR HARBOR FRONTING PROPERTY SIZE OF PROPOBED WORK ~! _ LENOTM / ~ ' / W I DTH HEIGHT ABOVE HIGH WATER DEPTH BELOW YARDS TO BE YARDS TO BE WIDTH OF CANAL, CREEK OR BAY FRONTING PROPEBTY AVERAGE RISE IN TIDE______.~/_~/~- DISTANCE TO THE NEAREST CHANNEL__~__/~-______FT, DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE IS THIS FOR PRIVATE OR BUSINESS USE? / ~Y' ~. ~. AREA MANNER ~N WHICH MATERIAL WILL BE REMOVED OR DEPOSITED INTENDED USE OF PROPERTY _~_~_/ DESCribE ~Y ~OWN P~IO~ OPErATIOnS AND WhETHE~ ANY ~RIO~ LICENSE O~ PERMITS ~AVE BS~N ISSUED TO E~EET STRUCTURES O~ TO D~EDGE O~ DE~OStT FILL O~ SAID ~EM]SES AND WHETHE~ ANY ~E~MITS O~ LICENSES WErE EVE~ ~USPE~DED O~ REVOKED BY A GOVE~NME~TA AGENCY DESCRIBE FULLY THE REHABILITATION AND PROPOSEE 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? ~}~ · · [= PR~)JECT D NUMBER - 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed Dy Applicant or Project spbnsor) SEQR 1. APPLICANT/SPONSOR = t 2. PROJECT NAME 3. PROJECT LOCATION: 4, PRECISE LOOATION (Street aaaress aha road ~terseoBons. oromment mnomarKs, em.. or provide map) 5. IS PROPOSED ACTION: [] New [] Expansion 6. DESCRIBE PRO;IECT BRIEFLY: j~ Modificat ion/alterat ior 7. AMOUNT OF LAND AFFECTED: . ~ Ultimate y acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ~Yes [] No If No. describe brie~ y 9. WHAT IS PRESENT LAND USE tN VICINITY OF PROJECT? '~rResidentia [] !ndustria [] Commercial [] Agrlculzure ~ Park/Forest/Ooen space [] Otner Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUND!NG NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY/FEDERAL, STATE OR LOCAL)? ~'Yes [] No If yes, list agency(s) and Dermit/aDurovms DzTC 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~No If yes, list agency name and oermit/aoarova 12. AS A RESULT OF PROPOSED ACTION W LL EX ST NG PERM T APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the Coastal Area, and you are a state agency, complete the CoastsI Assessment Form before proceeding with this assessment OVER 1 PART II--ENVIRONMENTAL A~"~SSMENT (To be con' Dieted by Agency) ~' ~_ A. DOES ACTION EXCEED ANY TYPE~-,'HRESHOLD IN 6 NYCRR. PART 617.127 If yes. coordinate the review urocess and use the FULL ~F. ~ [] Yes [] No S. WILL ACTION RECEIVE COORDINATED REV EW AS PROVIDED FOR UNLISTED ACTIONS JN 6 NYCRR, PART 617.67 if NO, a negative declaration may De suDerseuea 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 auality, surface or-groundwater quagty or quantity, noise levels, ex~sting traffic patterns solid waste DrodaCtion or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic or other natural or cultural resources; or commumty or neighbOrhood character? Explain briefly: C4. A community's existing plans or goals as of ficiaJJy adopted, or a change in use or intensity of use of ]and or other natural resources? Explain briefly C5. Growth. subseauent 3evelooment. or related activities likely [o be induced by the proposed action? Explain briefly. C7. Other impacts (inctgding changes in use of either auanmy or [ype of energy)? Explain briefly. D iS THERE OR iS THERE LIKELY TO SE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] NO if Yes, explain briefly PART IIIwDETERMINATION 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 Bffect should be assessea in connection with its ia) setting (i.e. urban or rural); (b) probability of occurring; (c} duration; id) rreversibility; (e) geographic scope: and if) magnitude. If necessary, add attachments or reference supporting materials. Ensure that exp/anations contain sufficient aetail 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 EAr and/or prepare a positive declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting aocumentation, that the DrODosed action WILL NOT result in any significant adverse environmental impacts AND nrovide on attachments as necessary, the reasons supporting this determination: COUNTY OF SUFFOLK ) STATE OF NEW YORK )SS: In completing this application I hereby authorize the Trustees. agent 0r representative to enter onto my property to inspect the premises in conjunction with review of this application. SIghT.RE O~ APPLICANT SWORN TO BEFORE M~ No. 5Z-~3z~m~ Te~m Ex,res EXAMINED APPROVED "WETLANDS" PERMIT (CHAPTER 97) APPROVED "~OAT DOCKS, WHARVES" PERMIT (CHAPTER 32) DISAPPROVED DISAPPROVED COND]TIONS, IF ANY (CHAPTER COMPUTATION OF FEES Aporoved 2/27/85 BOARD OF TOWN TRUSTEES ~ TOWN OF SOUTItOLD . - ~ 53095 Main Road Phone 765-1892 ~ ,0 3 2 0 S 8' i Southold, N. Y. 11971 ~ ~ ~ ~ Date~ ~/ 19 Y i BOARD OF TO~' TRUSSES I ~ ,14q6-~2 (2187)--7c '*~" 617.21 Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM SEQR Purpose: The fuji EAF is designed to help applicants and agencies determine. [n an orderl', manner, whether a project or action may be significant. The question, of whether an actjon may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are ~ubjective or unmeasureable. It iS also unde[stood that those who determine significance may have little o~ no formal knowledge of the environment or may be technicall~ e-Xpert in environmental analysis. In addition, many who have knowledge m one particular area may not oe aware of the br0aderconcerns affecting the question of significance. The full EAF Js intended to provide a method whereby applicants and agencies can be assured that the determination 0recess has been orderly, comprehensive in nature, yet flexible to allow introduction of information to fit a project or action, Full EAF Components: The full EAF is comprised of three parts: Part 1: Provides objective data and info:marion about a given project and its site. By identifying basic project data. it assists a reviewer in the analysis that takes place in Parts 2 and 3. Part 2: Focuses on identifying the range of possible ir~ pacts that may occur from a proiect or action. It provides guidance as to whether an impact is likel~ to be considered small to moderate or whether it is a potentiaJly- large ~mpact. The form also identifies whether an impact can be mitigated or reduced. Part 3: If any irt pact in Part 2 is identified as potentially-large, then Part 3 is used to evaluate whether or not the impact is actually important. DETERMINATION OF SIGNIFICANCE--Type 1 and Unlisted Actions Identify the Portions-of EAF completed for this project: [] Part 1 [] Part 2 {3Part 3 Unon review of the information recorded on this FAF {Parts 1 and 2 and 3 if appropriate), and any other supporting information and considering both [ne mag~tude and ~mportance of each impact, it is reasonably determined by the lead agency that: [] A. The prelect will not resul[ ,n any large and imeortant impact(si and, therefore, is one which will not have a s~gnificant impact on the enwronment, therefore a negative declaration will be prepared, [] B. Although the project could have a significant effect on the environment, there will not be a significant effect for this Unlisted Action because the mitigation measures desdribed 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 ~s only valid for Unlisted Actions Name of Acbon Name of Lead Agency Print or Type Name of Responsible Officer m Lead Agencv Title of Responsible Officer SignaTure of Responsible Officer m Lead Agency Signature of Preparer (if different from re~_ponsible officer) Date 1 PART 1--PROJECT INFORi~ATION · Prepared Dy Project Sponsor NOTICE: This document is designed to assist in determining whether the action proposed ma,. have a significant effec on the environment. Please complete the entire form. Parts A through E. Answers to these questions will be considerei 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 comz[ete Parts 2 and 3 It is expected that completion of the full EAF will be dependent on information currentlv available and wi[I not involv new studies research or investigation. If information requiring such additional work is unavailable, so indicate and specif each instance. NAME OF ACTION LOCATION OF ACTION (Include Street Address. Municipality and County) NAME OF APPL[CANTtSPONSOR BUSINESS TELEPHONE ) ADDRESS ~ -- CI~/PO STATE ZIP CODE ~AME OF OWNER []f different) BUSINESS TELEPHONE ADDRESS ~ CiTY/PO STATE ZiP CODE DESCRIPTION OF ACTION Please Complete Each Question--Indicate N.A. if not applicable A. Site Description Physical setting o~ overa project, both developed and undeveloped areas. 1. Present land use: E3Urban E31ndustria[ [~Commercial [~Residential (suburban) [~Rural (non-farm E3Forest E3Agriculture rqOther 2. Total acreage of proiect area: acres. APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION Meadow or Brushland (Non-agricultural) acres acres Forested acres acres Agricultural ( ncludes orchards, cropland, 3asture, etc.) acres acres Wetland (Freshwater or tidal a~ per Articles 24. 25 of ECL) acres acres Water Surface Area acres acres Unvegetated IRock, earth or fill) acres acres Roads. buildings and otner pavea surfaces ~cres acres Other (Indicate type) acres acres 3. What is predominant soil type(s) on prolect site? a. Soil drainage: []Well drained % of sate ~Moderate[,~ well drained % of site ~Poor[v drained % of site o. If any agricultura and is involved how mare acres of soil are classified within soil group 1 through 4 of the NYE Land Classification S,,stem? acres..See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? ~Yes E]No a What is depth, to bedrock? (in feet) 2 ',5. ~,pprox,mate percentage of p~posed project site with s!gpes: [Z]0-10 ~/a'/ % [310-15% % .~ [215% or greater % 6. Is project substantially contiguous to or contain a building, site, or dis}:rict, listed on the State or the National Registers of Historic Places? E2Yes [3No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? [2Yes [3No 8. What is the depth of the water table? [in feet) 9. Is site located over a primary, principal or sole source aquifer? E3Yes [Z]No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ~Yes [3No 11. Does project site contain any species of plant or animal life that is identified as threatened or endangered? I-lYes [3No According to Identify each species 12. Are there any unique or unusua] and forms on the project site? Ei.e., cliffs dunes, other geological formations) [3Yes [2No Describe 13. Is the project site presently used by the community or neighborhood as an open space or recreation area? [2Yes [3No If yes, explain 14. Does the present site include scenic views known to be important to the community? [3Yes ~No 15. Streams withir~or contiguous to project' area: a. Name of Stream and name of River to which it is tributarv 16 17. Lakes. ponds, werland areas within or contiguous to oroject area: a. Name Is the site served~y~xisting public utilities? [~Yes [3No a) If Yes, does sufficient ca(]ac~tv exist to allow connection? b) If Yes. will ~mprovements be necessary to allow connection? b.~Size (In acres) [3Yes I~No ~Yes 18. Is the site located n an agricultural district certified pursuant to Agriculture and Markets La~ A~ticle 25-AA Section 303 and 304? [3Yes [3No 19. Is the site located ~n or substantiailv contiguous to a Critical Environmental Area designate(] pursuant to Article 8 of the ECL. and 6 ',~YCRR 6t77 [3Yes rE)No 20. Has the site ever been used for the disposal of solid or hazardous wastes? [3Yes [3No B. Project Description 1. Phvsica; dimensions and scale of project (fill in dimensions as appropriate) a. Total contiguous acreage ow-ned or controlled bi project sponsor b. Proiect acreage to be developed: acres initially; c. Project acreage to remain undeve!o(]ed acres. d Length of proiect in miles: ~lf appropriate) e. [f the project s an expansion, indicate percent of expansion proposed f. ~umber of off-street parking spaces ex,sung g. Maximum vehicular trips generateo 3er hour h. If residential: Number and type of housing units One Faro ,. Two Famih nitial[v Ultimately i. Dimensions un feet) of largest proposea structure acres. acres ultimately. %; _; proposed (uoon completion of project)? Multiule Family height; width; j. Linear feet of frontage along a public thoroughfare project will occup~ i~? ~ Condominium length. ft. 3 2 How much natural materia'l (i.e. rock. earth, etc.l will be removed from the site? 3. Will disturbed areas be reclaimed? []Yes E]No [N/A a. If yes, for what intend_Z purpose is the site being reclaimed? b. Will topsoil be stock~iled for reclamation? I~Yes iNn c. Will upper subsoil be stockpiled for reclamation? [Yes I~No 4. How mare. 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 bv this project? [Yes E~No 6. If single phase project: Anticipated ~eriod of construction 7. If multi-phased: a. Total number of phases anticipated b. Anticipated date of commencement ;base 1 c. Approximate completion date of final phase d. Is phase I functionally dependent on subsequent phases? 8. Will blasting occur during construction? r-lyes FqNo 9 Number o[ iobs generated: during construction 10. Number of jobs eliminated by this project 11. Wil project r~equlre relocation of any projects or facilities? (number). tons/cubic ~ards months, (including demolition). month . year (inc]uding demolition). month year. I~Yes ; after project is complete []Yes ZINo If yes, explain 12. Is surface liquid waste disposal involved? [Yes iNn a. If yes, indicate type of waste (sewage, industrial etc.) and amount b. Name of water bodv into which effluent will be discharged 13 Is subsurface liquid waste disposal invo[ved? FqYes ~No 1-ype 14 Will surface area of an existing water bod'v increase or decrease by proposal? Exnlaic [Yes []No 15 s project or any portion of proiect located in a 100 year flood plain? 16 Will the project generate solid waste? /~Yes iNn a. If yes. what is the amount per month _ tons []Yes b. If ves. will an'existing solid waste facility be used? I~Yes iNn c. Il yes. g~ve name ; location d. Will any wastes not go into a selvage disposal system or into a sanitary landfill? e. It Yes. explain INn [~Yes f~No 17. Will the nrolect involve the disposal of solid waste? a. If ves. what is the anticipated rate of disposa[? b. If ves. what if the anticipated site life? 18 Wi[[ project use herbicides or nesticides? [~Yes []Yes INn tons month. years. []No 19 Will prolec~ -outinelv produce odors (more than one hour per day)? [~Yes 20 Will project ~roduce operanng no~se exceeding the local ambient noise levels? 21 Will prolect result in an increase in energy use? []Yes []No If yes . indicate type(s) ~No [Yes [No 22 f water supply is from wells, indicate pumping capacity gallons/minute. 23 Total antic ~ated water usage per dav gallons/da,.. 24. Does prbject involve Local, State or Federal funding? ~Yes [No If Yes, explain d 25. ~pprovals Require : Type Submittal Date City, Town, Village Board []Yes fiNo City. Town, Vii[age Planning Bo'ard fiYes I~No City, Town Zoning Board [~Yes []No City. County Health Department [~Yes fiNo Other Local Agencies fiYes ~No Other Regional Agencies E~Yes State Agencies I~Yes fiNo Federal Agencies Q-}Yes C, Zoning and Planning Information I. Does proposed action involve a planning or zoning decision? fiYes final- _ If Yes, indicate decision required: fizoning amendment fizoning variance fispeciaJ use permit I~subdivision fisite plan I~ne~ [revision of master plan [~resource management plan E3other _ 2. What is the zoning classification(s)of the site? 3. What is the m. ax~mum potential development of the site if developed as permitted by the present zoning? 4. What is the proposed zoning of the site? 5. What i.' the maximum potential development of the site if developed as permitted by the oroposed zoning? 6. [s the orooosed action consfstent with the recommended uses in adooted local land use plans? fi]Yes 7. What are the predominant land use(s) and zoning classifications within a ~/~ mile radius of proposed action? fiNo 8. rs the proposed action compatible with adjoining surrounding land uses within a 7/, mile? 9. f the proposed action is the subdivision of land. how many lots are proposed? a. What is the minimum lot size proposed? 10. Wi] uroposed action require any authorization(s) for the formation of sewer or water districts? 11. Wil the proposed action create a demand for any community provided services (recreation. education, police, fire protection)? fiYes fiNo a. If yes, is existing capacJt,, sufficient to handle projected demand? I~Yes 12. Will the proposed action result in the generation of traffic significantly above present levels? a. If yes, is the existing road network adequate to hand e the additional traffic? D. Informational Details ~ttach any additional informanon as may oe needed to clarify your project. If there are or may be any adverse impacts associated with your aroDosal, please discuss such im 3acts and the measures which vou propose to mitigate or avoid them. E. Verification I certify that the information ~rovided above is true ro the oest of mv knowledge. Applicant/Sponsor Name Date Signature Title If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment.- - 5 Part , PROJECT IMPACTS AND TH~ A MAGNITUDE Responsibility of Lead Agency General Information (Read Carefully) · n completing the form the reviewer should be guided by the question: Have m,, responses and determinations beer reasonable.~ The reviewer is not expected to be an expert environmental analvst. · 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 s~gnificance. Identifying an impact m column 2 simpl, asks that it be looked at further. · The Examples provided are to assist the reviewer by showin =~ types of impacts and wherever, possible the threshold o magnitude that would trigger a response in column 2. The examples are generally applicable ti~'roughout the State anc for most situations. But. for an', specific project or site other exam oles and/or lower thresholds may be appropriat~ for a Potential Large Impact response, thus requiring evaluation in Part 3. * The impacts of each prelect, on each site, in each locality, will vary. Therefore. the examples are illustrative anc have been offered as guidance. They do not constitute an exhaustive list of impacts and thresholds to ansx4er each question o The number of exam pies 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 there will be any ~mpacc b. Maybe answers should be considered as Yes answers. ' ' c. f answering Yes to a question then check the appropriate box (column I or 2) to indicate the potential size of the impact. If impact threshold equals or exceeds an'~ example provided, check column 2. If impact will occur but threshold is lower than e~'ample, 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 n column 3. A No response indicates that such a reduction is not 3ossible. This must be explained in Part 3. I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] []Yes ~No [] [] []Yes []No L~ [] []Yes []No [] [] []Yes []No [] [] []Yes []No [] ~ ~Ves ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes IMPACT ON LAND 1 Will the proposed action result in a phi sical change to the project site? E3NO E3YES Examples that would apply to column 2 · Any construction on slopes of 15% or greater. (15 foot rise per 100 foot af length), or where the general slopes in the project area exceed 10%. · Construction on land where the depth ~co 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 I ,.ear or involve more than one phase or stage. · Excavation for mining purposes that would remove more than 1.000 tons of narura~ material (i.e.. rock or soil) per year. · Construction or expansion of a sanitary landfill. · Construction in a designated floodway. · Other meacrs 2. Will there be an effect t(....,y umqae or unusual land forms found on the site? (i.e., cliffs, dunes, geological formations etc.)~NO ~YES · Specific Idnd forms: 6 IMPACT ON WATER 3 Will proposed action affect any water body designated as protected? (Under Articles 15, 24, 25 of the Environmental Conservation Law, ECL) ~NO []YES £xam[~ [es 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. · Extension of utility distribution facilities through a protected water body. · Construction in a designated freshwater or tidal wetland · Other ~mpacts: 4. Will proposed action affect any non-protected existing or new body of water? [NO [~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. Will Proposed Action affect surface or groundwater quality or quantity? ~NO fqYES £xamples that would apply to column 2 · ' Proposed Action~.~will~requ]re a discharge permit. · Proposed Action requires use of a source of water that does not have approval to serve proposed (project) action. · Proposed Action reou~res water supp~3 from wells with greater than 45 ga[ions 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 cohYeyed off the site to facilities which presently do not exist or have inadequate capacity. · Proposed Action would use water m excess ot 20.000 gallons per day. · Proposed Action wii likely cau~;e si!tatio~ 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 1,100 gallons. · Proposed Action wil allow residential uses in areas without water aha or sewer services. · Proposed Action locates commercial and/ur industrial uses which may reauire new or expansion of existing waste treatment aha/or storage facilities · Other impacts: 6 Will proposed action alter drainage .How or patterns, or surface water runoff? [~NO ~YE$ Exar~ples that would apply to column 2 · Proposed Action would change flood water flows. 7 I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change ' [] [] []Yes [][No [] [] []Yes []No · fi[ [] []Yes []No [] [] []Yes . []No [] [] []Yes I-1No [] [] r~Yes []No [] [] []Yes []No [] [] []Yes []No [] ~ []Yes []No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ZYes ~No ~ ~ ~Yes _ ~No ~ ~ ~Yes ~No ~ ~ .. ~Yes ~No ~ ~ ~Yes ~No · 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? I~NO [~YE$ 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 I [on of refuse per hour. · Emission rate of total contaminants will exceed 5 ihs. 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: rMPACT ON PLANTS AND ANIMALS 8. Wi Proposed Action affect any threatened or endangered soec~es? [~NO ~YES 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 an'/ portion of a critical or significant wildlife habitat. · Application of pesticide or herbicide more than twice a year. other ~nan for agricultural purposes. · Other impacts: 9 Wi] Proposed Action st bstantial]v affect non-threatened or non-enaangered species? ~NO ~YES Examples that would apply to column 2 · Proposed Action would substantially qterfere with an,/ resident or m~gra~orv fish. shellfish or wildlife species. · Prooosed Action reca~res the removal of more than 10 acres of mature forest (over 100 years of age; or other locally imoor[ant IMPACT ON AGRICULTURAL LAND RESOURCES 10 Will the Proposed Action affect agricultural land resources? [~NO ~YES Examples that would apply to column 2 ° The proposed action wou[d sever cross or hmit access toagricultura[ [and includes cropland, hayfields, pasture, vme~ ard, orchard, etc.) Small to Potential Can Impact 'Be Moderate Large Mitigated By Impact Impact Project Change [] [] I~Yes []No -[] [] [~]Yes []No [] [] []Yes []No [] [] - []Yes [~]No [] E3 I-lYes []No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~ ~Yes ~No ~ ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No · Construction activit'y wou[d excavate or cpmpact the soil profile of agricultural land. · The oroposed action would irreversibly convert more than 10 acres of agricultural land or, if located in an Agricultural District. more than 2.5 acres of agricultural land. · The proposed action would disrupt or prevent installation of agricu]tura] 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 pc~ort¥ due to increased runoff) · Other impacts: IMPACT ON AESTHETIC RESOURCES ~J3. WiJ proposed action affect aesthetic resources? [~NO E3YES {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 proiect components visible to users of aesthetic resources__which will eliminate or si~ 3ificantl,. reduce their enjoyment of the aesthetic qualities of that resource. · Project components that will resu*t in the elimination or significant screemng of scenic v~ews known to be important to the area. · Other ~mpac[s: IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES 12 Will Proposed Action impact any site or structure of historic, pre- historic or paleontological importance? ~]NO [~YES Examples that would apply to column"2 · Proposed Action occurring wholly or partiall', within or substantially contiguous to any facility or site listed on the State or National Register of historic places. · Any impact 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 [he quantity or c~ualitv of existing or future ooen spaces or recreational OUDOrtunltJes.~ Examples that would appN 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: I 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] []Yes [] [] [~Yes I-qNo ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ i ~Yes ~No .~ ~ ~Yes ~No - ~ ~ ~Yes ~No IMPACT ON TRANSPORTATION 14. Will there be an effect to existing transportation systems? [ZINO r~YES Examples that would apply to column 2 · Alteration of present patterns of movement of ~eople and/or goods. · Proposed Action will result in maior traffic problems. · Other ~mpac[s: IMPACT ON ENERGY 15. Will ~roposed action affect the community's sources of fuel or energy supply? E]NO EYES Examples that would apply to column 2 · Proposed Action will cause a greater than 5% 'ncrease 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? [Z]NO Examples that would apply to column 2 · 3lasting within 1.500 feet Qf a hospital, school or other sensitive facilitv. · Odors wil]occur routineh (more than one hour Der oaw. · Proposed Action will produce operating noise exceeding the local ambient noise levels for noise outside of structures. · Prooosed Action will remove natural barriers that would act as a noise screen. · Other ~mpacts: IMPACT ON PUBLIC HEALTH Will Proposed Action affect public health and safetv? [Z]NO [Z]YES Examples that would applv 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. · Prooosea Action may result in the bu"iaJ of "hazardous wastes" in an~ form (i.e. toxic, poisonous, highly reactive, radioactive, irritating, infectious etc.) o Storage facilities for one mu ~on or more gallons of liquified natural gas or other flammable liauids. · Proposed action may result in the excavation or other disturbance within2000 feet of a site usea for the disposal of solid or hazaraous waste. · Other impacts: I 2 3 ~ Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] [~]Yes [~No [] [] []Yes [-1No [] -~' []Yes []No [] ~ [] []Yes E~No [] ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes _ ~No ~ ~ - ~Yes ~No ~ ~ ~Yes ~No ~ ~ ~Yes ~N0 10 IMPACT ON GROWTH ~AND CHAF~A'~~'' OF COMMUNITY OR NEIGHBORHOOD 18. Will proposedactionaffectthecharacteroftheexistingcommunitv? E3NO [~YES Examples that would apply to colu mn 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 munic~ga] budget for capital expenditures or operating services will increase by more than 5% per year as a result of this prolect. · 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 faci[ities, structures or areas of historic importance to the community. · Deve]opmentwil[ createa demand for additional community services [e.g. schools, po[ice and fire, etc.) · Proposed Action will set an important precedent for future projects. · Froposed Action will create or eliminate employment. · Other impacts:. I 2 3 '' Small to Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change [] [] []Yes [] [] ' []Yes [~]No [] [] []Yes []No [] [] []Yes []No ~ ~ ~Yes ~No ~ ~ ~fes DNo ~ ~ ~Yes ~No ~ ~ ~Yes ~No 19. ls there, or is there [ikelv to be. public controversv related to potential adverse environmenta[ impacts? E3NO ~YES If Any Action in Part 2 Is Identified as a Potential Large Imt~act or If You Cannot-Determine the iVlagnitude of Impact, Proceed to Part 3 Part 3--EVALUATION OF THE IMPORTANCE OF IMPACTS 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 Iii applicable) how the impact could be m~tigated or reduced to a small to moderate impact by proiect change(s} 3 Based on the information available decide if it is reasonable to conclude that this impact is important. To answer the question of ~mportance, consider: · The probabilitvof the mpact occurring · The duration of ~ne imoact · Its irreversibilitv, including permanently lost resources of value · Whether the im3act can or wi, be controlled · ]-he regional conseaaence of the ~mpac~ · Its potential divergence from local needs and goa~s · Whether known obiecuons to the proiect relate to this imDact (Continue on attachments) 11 · 617.21 SEQR Appendix B , Slaie Environmental Quahty Review Visual EAF Addendum This form may be- used tc provide additional information relating to Question 11 of Part 2 of the Full EAF, /To be completed by Lead Agency) Distance Between 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 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? · Statz Parks? · The State Forest Preserve? · National Wildlife Refuges and state game refuges? · National Natural Landmarks and other outstanding naturaL features? · National Park Service lands? · Rivers designated as National or State Wild. Scenic or Recreational? · 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? Project and Resource (in Miles) O-IA 1/~.I/2 1/2-3 3-5 5 + [] [] F- [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [] [s the visibility of the project seasonal? ~.~ e.. screened by summer foliage, but visible during other seasons) l~Yes 3. Are any of the-resources checked in question 1 used by the public during the time of year during which the project will be visible? ~ Yes [] No DESCRIPTION OF EXISTING VISUAL ENVIRONMENT 4. From each item checked in question 1, check those which generally describe the environment. surrounding Within · 1/4 mile * 1 mile Essentially undeveloped [] [] Forested [] [] Agricultural [] [] Suburban residential [] [] Industrial [] [] Commercial [] [] Urban [] [] River. Lake, Pond [] [] Cliffs. Overlooks [] [] Designated Open Space [] [] F at [] [] Hilly [] [] Mountainous [] [] Other ~ ~'- [] NOTE: add attachments as needed 5. Are there visually similar projects within: '1/2 mile []Yes F~No '1 miles []Yes []No *2 miles []Yes []No *3 miles []Yes []No * Distance from project site are provided for assistance. Substitute other distances as appropriate. EXPOSURE 6. The annual number of viewers likely to observe the proposed project is NOTE: Whe~ user data is unavailable or unknown, use best estimate. CONTEXT 7. The situation or activity in which the viewers are engaged while viewing 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 [] [] [] [] 3. Nature of work (check which aPplicable): New Building .......... Addition ./..~. ..... Alteration .... : .... Repair ............. Removal .............. · D~motltion .... : .......... Other Work .............. k.~:I (DescrJptiorl) 4. Estimated Cost. OO~3-ob Fee tto be paid on filing this application) 5. If dwelling, number of dwelling units ff~ Number Of dwelling units on each floor If garage, number of cars 6. If business, commerclal or ,nixed occupancy, specify nature and extent of.each type of use ?. Dimenslo~sofex~i~gstruetures,~f~ny:Front,. ~ ........ Rear , ~9. .' , Depth., ~ lteight ..... e~. ....... Number6fStories. ~ ....... ' . ' ................. Dimensions of s~me structure with alterations or additions: Front ...~O .......... Rear .. ~TQ ........... Depth .... '~.~ .............. Height ..... ~.' ............. Number of Stories ...... ~ ............... 8. Dim&nsmus of entire uew construction: Front .............. Rear . _ .~.~'. ........ Depth .... ~7./ ........ tteight ...... /.3 ....... Number of Stories ........ ~ .................................... 9. Size o[t6t: Front ... ~ ............. Rear 7~%~ ............... Depth i. 1~¢ ......... I0. Date of Purchase ............................ Name of Former Owner ........................... 1 t. Zone or use district in which premises are situated ' 12. Does proposed construction violate any zoning taW. ordinance or regulation: ... ~O ........................ 13. Will lot be regraded ..... ~ .......... . ....... Will excess fill be rent, ed from premises: Yes 14. N~ue of Owner of premises ... ~ 0~.¢;.. kk~{.t~Address .. 7{91~ ¢}%..-~ ~.. Phone No. ? :)~t.L 6s~9 N~m~ of Archit~cI ..~...~: ............... Address ................. Phone No ............ Name.of Contractor . ~ ~ d... J~t I~l ¢.~ ...... Address .. B~O., '5~2i~. ~Phone No. ,~f~g 7~.c2 Is this property within 300 feet of a tidal wetland? ~'Yes...;.0... No ......... " · If yes, Southold Town Trustees Permit may be required. PLOT D [AG~M Locate clearly and distinctly ~1 buildings, whether existing or proposed, ~d, indtcate all set-back dimensions from property lines. Give street and block number or description accord~g to deed, and show street names and indicate whether interior or corner lot. ~ ..... ~ ~ ~ ('q~ 15. STATE OF NEW. eYORiI~Q \ ~ COUNTY OF . . .'~ .t_?. 3.. 9 ....... S.S t)O,'lne ...................... fName of individual signing contract) above named. being duly sworn deposes and says that he ls the applicant (Signature of applicant) (Contractor. agent, corporate officer, etc.) said owner or owners and is duly authorized to perform or have performed the said work and to make and file this ~ication: that all statements contained in tlris application are true to tile best of his knowledge and belief: and that the wi/l be perfo~ed in the manner set forth in the application filed therewith. , to before me this ....... ..... or. .... · ~ "w York NoI~W Public, State o ~-~ ~o ~9-812~8~0, Suffolk ~o~ T~r~ '~xt~ir~S Oetobo~ 3L 1 g~