HomeMy WebLinkAbout1000-102.-3-1 1000-102-2-12.2
JOSEPH P DUNN,29475 RT 25,CUTCHOGUE NY 11935 1000-103-07-30
1000-102-2-12.6 DAVID&SHARON COUGHLIN,PO BOX 476,CUTCHOGUE NY 11935
DEPOT ENTERPRISES,C/O JUDITH LIZEWSKI 7 TUDOR LN.,BEL AIR MD 21015 1000-103-07-31
1000-102-2-13 DEBORAH&WILLIAM GILDERSLEEVE,PO BOX 460,CUTCHOGUE NY 11935
_ ALEXIS MAIDA,29745 MAIN RD,CUTCHOGUE NY 11935 1000-103-07-32.1
1000-102-2-14 STEPHEN DECKER,245 1T ST,CUTCHOGUE NY 11935
US BANK TRUST NA,13801 WIRELES WAY,OKLAHOMA CUTY OK 73134
1000-102-2-15 I 1000-103-11-2
' EMILY G.VICTORIA TRUST,25325 MAIN RD,CUTCHOGUE NY 11935 CHARLES&JULIE RAUCH,3820 TIANA ST,SEAFORD,NY 11783
' 1000-102-02-16.2 / 1000-103-11-3
LEWIS EDSON,30105 RT 25,CUTCHOGUE NY 11935 AMY HILL,570 PEQUASH AVE.,CUTCHOGUE NY 11935
o� 1000-102-02-17 1000-103-11-4
ALLAN P.VANNAME,PO BOX 11,CUTCHOGUE NY 11935 EVELYN WOELKER,660 PEQUASH AVE,CUTCHOGUE NY 11935
1000-102-02-18 1000-103-11-1.2
LILLIAN HAMID,30325 RT 25,CUTCHOGUE NY 11935 WICKHAM'S FRUIT FARM,PO BOX 928,CUTCHOGUE NY 11935
\� tp� 1000-102-02-20 1000-103-11-05
// MARY 10 BAILEY 30485 RT 25,CUTCHOGUE NY 11925 JUDITH BARRY,39 SPRING STREET,NEW YOR NY 10012,
`�� 1000-102-02-23.3 --- -- — -------
,9 CUTCHOGUE CEMETERY ASSOC.
1000-102-03-01
RQA PROPERTIES LLC,29950 RT 25,CUTCHOGUE NY 11935
' 1000-102-03-02
0° , ELIZABETH MURPHY,230 PEQUASH AVE.,CUTCHOGUE NY 11935
o� ,°� '9L 1000-102-03-5.1
MICHAEL&CAROL SENDLEWSKI,270 PEQUASH AVE.,CUTCHOGUE NY 119 35
DO \° \0 1000-102-03-06
' o� /O PATRICIA&WILLIAM GILDERSLEEVE,165 PEQUASH AVE.,
1000-102-03-07 CUTCHOGUE NY 111935
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0> SOUNDVIEW HALL LLC,13235 MAIN RD.,MATTITUCK NY 11952
/
000-
O \ o° o\ 1000-102-03-08
0O \ COUNTY OF SUFFOLK,330 CENTER DRIVE,RIVERHAD NY 11901
1000-102-03-09
w THOMAS FISCHER,250 VETS MEM.HWY.HAUPPAUGE,NY 11788
1000-102-03-10
RICHARD CIFERELLI,PO BOX 782,CUTCHOGUE NY 11935
9
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JOHN&MARGARET SMYTH,PO BOX 909
T CUTCHOGUE NY 11935
1000-103-01-07
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O �' �+ METHODIST EPISCOPAL CHURCH,PO BOX 1286,CUTCHOGUE NY 11935
1000-103-01-9.1
\( \h �ry0 Yf•� \° \°� �` 0 " CO CHA G SEAFOOD,INC.285 STILLWATER AVE.,CUTCHOGUE NY 11935
�'�• �ti o° o, ,h0 1000-103-01-10
ti O' �` T ° O CHRISTA WILDERBRAND/JEFF ABRAMS 425 STILLWATER AVE.M CUTCHOGUE NY 11935
1000-103-07-01
/ V MARGERY AUERBACH,PO BOX 208,CUTCHOGUE NY 11935
I 0 O e O 1000-103-07-02
O �\ KARVOUNOSKALA HOLDING CORP,213-37 39TH AVE.,STE 199,BAYSIDE NY 11361
.0 p� e/ 1000-103-07-03
��•. KONRAD KLAUER&GWEN KRASILOVSKY,430 STILLWATER AVE.,CUTCHOGUE NY 11935
1000-103-07-6.1
PETER SCHOTT,PO BOX 49,CUTCHOGUE NY 11935
�/ `� °O3'• �O �� 1000-103-07-26
h O ALFRED TRODIA LIVING TRUST&CATHERINE DOSCH LIVING TRUST,665 PEQUASH AVE.,CUTCHOGUE,NY 11935
/ FS •SCK -9 �( pc 1000-103-07-27.1 _
' s�C, � JANE KRONE TRUST,200 CENTRAL PK SOUTH,APT 181,NEW YORK NY 10019
I Opp 7' 1000-103-07-27.2
5• O SCOTT EDGETT,685 TRACK AVE.,CUTCHOGUE NY 11935
1000-103-07-28
CHRISTOPHER CHRISTINE PEDDY,445 PEQUASH AVE.,CUTCHOGUE NY 11935
\ /% �• ��� �� KENNETH&JANICE ROBINS,365 PEQUASH AVE.,CUTCHOGUE NY 11935
No-
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'¢o - o� 4 MAP FOR ZONING CHANGE
RICH'S QUALITY AUTO REPAIR
,�.,o AT CUT CHOGUE
o� 1 ,�° TOWN OF SOUTHOLD
0 0°° F�`'� °•� SUFFOLK COUNTY N. Y.
1000 - 102 - 03 - D�
�• y ° Scale: 1",
- 100
JULY - 15, 2010 RECEIVED
JULY 5, 2018
�o 11IG 2 3 4 713
0
o° Southold Town Clerk
• of VIEW),(,' 1
SUFFOLK COUNTY SECTION 8 BLOCK LINE
OWNERt
-- - - - - - - ZONING DISTRICT LINE
RICH BOZSNYAK-
D r DWELLING RGA PROPERTIES LLC
29950 RTE. 25 (P.O. BOX 320) N.Y.S. LIC. NO. 496/8
B BUILDING CUTCHOGUE, N.Y.
11935CO)V/CASYORS, P.C.
G GARAGElV (63U`765'-15020 FAX (631 765 - /797
P. 0. BOX 909
o - OFFICE • -
1230 T
RAVEL ER STREET10-162
O_162
SURVEY OF PROPERTY
AT CUTCHOGUE
TOWN OF SO UTHOLD
/ SUFFOLK COUNTY, N. Y.
/
1000-102-03-01
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41•`�. `�' N.Y.S. LIC. NO. 49618
ANY ALTERATION OR ADDI77ON TO THIS SURVEY IS A V10LA77ON OF
SEC77ON 72090F THE NEW YORK STATE EDUCAT70N LAW. EXCEPT ASAf�EA=37 421 SQ. �. ECONIC ,SURVEYORS, P.C.
PER SEC77ON 7209-SUBDIVISION 2. ALL CER77FlCA77ONS HEREON , (631) 765-5020 FAX (631) 765-1797
ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF SAID MAP P.Q. BOX 909
OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE
SIGNATURE APPEARS HEREON: 1230 TRAVELER STREET
SOUTHOLD, N.Y. 11971 -1 -162
N SURVEY OF PROPERTY
AT CUTCHOGUE
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000--102-03-01
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ELIZABETH A. NEVILLE, MMC ���l � °" Town Hall, 53095 Main Road
TOWN CLERK � P.O.Box 1179
Southold,New York 11971
REGISTRAR OF VITAL STATISTICS �u Fax(631)765-6145
MARRIAGE OFFICER �µ „ Telephone(631)765-1800
RECORDS MANAGEMENT OFFICER �� � . ;°, www.southoldtownny.gov
FREEDOM OF INFORMATION OFFICER
OFFICE OF THE TOWN CLERK �� �! ! ..
TOWN OF SOUTHOLDIf
0�h� c
....f rrl ....
To: William M. Duffy, Town Attorney
Heather Lanza, Planning Director --J
nN
From: Elizabeth A. Neville, Town Clerk
Re: Change of Zone Application of RQA Properties, LLC
Date: August 23, 2018
Enclosed is the change of zone application submitted by the applicant's s agent, Michael A.
Kimack on August 23, 2018. Please review it and send me your comments and
recommendations.
Thank you.
cc: Supervisor & Town Board Members (copies will be available in Laserfiche)
• NAME OF APPLICATION: R A Properties, LLC
DATE:
❑ Check means item is complete ❑ Circle means item not complete
CHECKLIST FOR REZONING PETITION
TC TA PB
❑ ❑ ❑ Four (4) complete copies of petition with Town Clerk with original signatures.
Each set
MUST be ordered as follows:
❑ ❑ ❑ Fee of$1,000.00 ($500.00 for AHD)
❑ ❑ ❑ Written notice to all property owners within 200' of property; mailed within 5
days
Preceding filing of petition
❑ Il ❑ File proof of mailing of notices to adjacent property owners in a sworn statement with
Clerk's office and submit all original certified mail postal receipts
NOTICE MUST CONTAIN:
0 Statement Of Proposal (as presented in zoning petition)
9 Description Of Property
Present Zone And Proposed Zone
Petition Will Be Filed Within 5 Days
0 Petition Can Be Reviewed In Clerk's Office
0 Public Hearing Must Be Held
o Adjacent Owners Right To Be Heard @ Hearing
0 10 Days Before Hearing Notice Published
❑ ❑ ❑ Meet all requirements for submitting zoning action pursuant to section 239
L &M of General Municipal Law attached hereto
❑ If applicable, file waiver of notice from property owner w/the clerk's office
❑ ❑ ❑ Six (6) maps drawn at the 1"= 100' scale in accordance with attached
information sheet.
❑ ❑ ❑ Six (6) sketch plan maps at the 1" = 100' scale or the 1" =20' scale in
accordance with
attached information sheet.
The procedural requirements appear to have been met by this application:
Town Clerk IT DateR/Q3 hg>
r pnature
Town Attorney Date
Signature
Planning Board Date
Signature
IS
(1P
ELIZABETH A. NEVILLE � r Town Hall, 53095 Main Road
TOWN CLERK P.O. Box 1179
REGISTRAR OF VITAI.STATISTLCS
Southold, New York 11971
MARRIAGE OFFICER Fax (631) 765-6145
RECORDS MANAGEMENT OFF'IC:ER Telephone (631) 765-1800
FREEDOM OF INFORMATION OFFICERsoutholdtown.northfork.net
40 f{
RECEIVED OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
AUG
RE ` UEST FOR,4 fff, 1 DAIF!, � .41VDIOR CHANGE OF'ZONE,
Southoldf uWril r
APPLICATION NAME:
Reo?.46 - ��.- ......._� ....._ _
(Name under which application shall be known)
SUFFOLK COUNTY TAX MAP NO.: 1000 - ..�Q pO --0Q - n 2f QQQ
District Block Parcel
A. SUBMISSION INFORMATION:
Application is hereby made to the Southold Town Board for amendment to Chapter 280
{Zoning) of the Town Code and/or a change in the zoning classification of the Zoning
Map in accordance with the Section 280 - fi of the Zoning Law of the Town of Southold
and Section 265, Town Law.
Further, the following are submitted herewith (check those appropriate, write N/A where
not applicable)
1. Four (4 ) sets of the completed application form and petition. Each set shall contain
one (1) complete set of cover letter forms, affidavits, project description, surveys,
plans, and EAF and any supplemental information as maybe be needed or requested.
2. Fee in the amount of$1,000.00 ($500.00 for AHD). Applicant is also responsible for
any fetes incurred in the Environmental Review Process.
_Z3. Survey map, accurately drawn to appropriate scale, showing the proposed zone
district boundary changes, property liners, the calculated areas affected, in acres or
square feet, the Suffolk County Tax Map designations, the street rights-of-way in the
immediate vicinity and lands, land uses and names of owners immediately adjacent to
and extending within five hundred (500) feet of all boundaries of the property to be
amended.
t,,"4. Metes and bounds description of the proposed amendment.
10/1/2008 1
5. Appropriate Environm ental Assessment Form (EAF). All Unlisted and Type I
Actions require either a Short or Full EAT to be prepared. See Chapter 130 of
Town Code and Part 617 NYCRR (SEQR), or check with the Town Attorney and/or
the Planning Department,
6. Other information deemed necessary for review by the Town Board, the Town
Planning Board and/or the Suffolk County Planning Commission (i.e. site plans,
subdivision maps). Please note iterns submitted:
B. GENERAL INFORMATION:
Name Of Applicant(s)
Address: _
Telephone No. _......
If the applicant does not own the property, is a contract vendee, or if the owner is
a Corporation or a Partnership, prepare endorsement at the end of this form
establishing owner's authorization of the applicant's request.
2. If the applicant is contract vendee, give name. If the applicant is a corporation (or
partnership), give the name and title of the responsible officer:
Name: "` " Title: f m
Address:(if different)_ - .�... '_CZ
Telephone No.: ,371 5";� —
1 Landowner(s): �� , Title ITW
Address: _.
Telephone No.:
4, Name of licensed architect, landscape architect, civil engineer and/or surveyor who
prepared the plan:
Name: J20MAI jitle:
Name of Firm:_ � a "�
Address. dG,L � _W
w
Telephone No.:� "�' m
5. Name of Attorney, or Agent authorized to represent the property owner anti/or applicant:
Name eg 4"1 ! j< � .... Title:_�G _ .
Name of 1°ir ni:�___
�
Address;
Telephone No.:
10/1/2008 2
6. All communications with regard to this application shall be addressed to the following
person until further notice:
Name:___ .. � '1� . _ Title.
Address:-_
Telephone No.......—,,.
C. SITE/PROJECT DATA:
1. Location of Property .�� side corner of_
(north/south/east/west) stre
( et)
MAVIV R-9" / 0..� feet s ,..
or ( tll east/west)
of Z
(nearest intersecting street) (hamlet)
2. Existing zoning district(s) _ -�
Special Overlay District(s), if applicable-.-
3. Requested zoning district(s) �
4. Lot area: --?7, .42,1 sq. ft or acres �f
5. a. The latest deed(s) describing this parcels) is (are) recorded in the County Clerk's
Office as follows:
DATE LIBER PAGE
b. A copy of the(se) should be attached to the application.
6. There are no encumbrances or liens against this land other than mortgages?
DYES NO
7. All buildings and structures are shown on the survey? � YES NO
(The Town Board reserves the right to request a complete survey showing all existing
structures.)
8. Existing: Building Area 71Z2, 44f sq. ft. Lot coverage 197,0_
9. Please attach a detailed typewritten description of the project, the proposed use and
operation thereof, including a detailed explanation of the design concept, the reason for
the particular design, objective of the devet()])el• 01- p)rojeet sponsor and how or why (lie
1�iroject is (or is not) imps cornplialice with the Town ,"ode acid the Master lllall. l�xplain
what benefits accrue to the co mnniiiit)° by the ])roposed rezoning, I oc.uaneiit i,casons
10/1/2008 3
why proposed project can not be built under current zoning regulations and pursuant to
the current zoning map.
D. AGENCY COORDINATION AND SEQRA (See Part 617, NYC:RR and Chapter 130 of
Town Code)
I� Does the site Front on a Town, County of State Road? (circle one)
Name and number of the road (i.e. County Road 48, State Road 25)
2. is the site within any other areas of review of the Sufl'blk County Planning; Comniission?
PlannrngCommissron4NO. If yes, the referral requirements of the Suflblk County
should be examined to assure a complete application.
3. Is the site in a designated critical environmental area as per the New York State
Environmental Quality Review Act (SEQRA) and Chapter 130 of the Town Code?
YES ?/ NO. If yes, what area?
4. Type I, Type II o Unlisted Action circle one)
An environme, tag s r-n-i must be completed for Unlisted and Type I actions,.
5. Has an Environmental Assessment Form:or Draft Environmental Impact Statement been
prepared? l/ YES _ mNO. If yes, copies should be submitted with the
application.
E. I hereby depose and certify that all of the above statements of information, and all
statements And information contained in the supporting documents and drawings
attached hereto are true and correct.
APRICANT'S
Sworn before nye this
day of L 20
NOTARY PUBLIC
MICHAEL A. KIMACK
Notary Public,State of New York
No.02KI5056822
Cuallfied In Nassau County
Commission Expires March 11,2022
10/1/2008 4
F. OWNER'S ENDORSEMENT (To be signed if applicant is not the owner or if the owner
is a corporation or partnership)
State of New York
County of Suffolk
r � ✓ " � ' ._ �� ".. .......—being duly sworn, deposes and
says that he/she: resides at ,— �..... ', "/ � �'' :. t ' _
in the County of _S!/FFOL,(C and the State of AIEW YoRk
and that he/she is (the owner or the officer of the corporation or partnership which is the owner
in fee (circle)) of the premises described in the foregoing application and that he/she has
authorized
to make the foregoing application for amendment and/or change of zone as described here in.
NAME
SIGNAI J RL
L corporation,.� E��
name of corporation and
Officer's [it]
Sworn before me this L•3f� r �. $OZSiYY.4�'� 1��/y��
Day of&X�, 20jy
NOTARY PUBLIC; ._ .m.
MICHAEL X ICIMACK
Notary Public,State of New York
No.02K15056823
()ualified in Nassau Gaunt
Ommission Expires March 11,2022.
10/1/2008 5
G. DISCLOSURE AFFIDAVIT
State of New York
County of Suffolk
_ being by me duly sworn, deposes and says:
1. 1 am an applicant for a project or an owner of"the land which is the subJect of a pending
application before the Southold Town Botrrd for-a� e�nidment and/or change of zone.
2. The project name is; /ice__
3. I reside at '7 M
4. The Officers of the applicant corporation or owner corporation are as follows:
NAME TITLE
5. I make and complete this affidavit under the penalty of perjury and swear to the truth
herein.
6. 1 ain aware: that this affidavit is required by General ,Municipal Law 819 and that I shall
be gLidty of a misdemeanor yrs provided by General Municipal Law 8'09 should I
knowingly or intentionally fail to make all disclosures herein.
T During the 12 months before the filing of this application, have any of the folloirag
individuals made campaign contributions exceeding $100 in total, in cash or �ill kind, to
members of the Town Board or political conli-nittees designated to accept donations
behalf:
Yes No
1. Owner
2. Applicant .......r
3. Agent for owner or applicant
4. Attorney _�
5. Other �
10/1/2008 6
If the answer to Question 7 is yes, Town Code Chapter 26 require that the information be
provided below:
Name Title LOwner, Ag nt,_Aitto a e _other Amount
For the purpose of this disclosure, an official or employee or either the Town of Southold or the
County of Suffolk, shall be deemed to have an interest in the applicant and or owner when that
official or employee, their spouse, brothers, sisters, parents, children, grand children or the
spouse of any of them:
a. Is the applicant or owner
b. Is an officer, director, partner, or employee of the applicant or owner
c. Legally or beneficially owns or controls stock of a corporate applicant or owner,
or is a member of a partnership or association applicant or owner, or
d. Is a party to an agreement with the applicant or owner, express or implied,
whereby said official or employee may receive any payment or other benefit—
whether or not for services rendered, dependent or contingent upon the favorable
approval of such application.
Ownership of less than five percent of the stock of a corporation whose stock is listed on the
New York Stock or American Stock Exchanges shall not constitute an interest for the purposes
of this disclosure
YOU MUST ANSWER THE FOLLOWING QUESTION YES OR NO
Do any of the following individuals have an interest in the applicant or owner, as defined above?
YES NO
1, Any official New York State YES
2. Any official or employee of Southold Town or Suffolk County? YES NO
If the answer above is yes, to any of the questions, General Municipal Law Section 809 requires
that you disclose the name and residence and the nature and extent of the Interest of said
individual (s) in the applicant or owner.
NAME RESIDENCE NATURE OF INTEREST
10/1/2008 7
SIGNA
Z:. OOZSN VW-, Je
Sworn before me this 1-4
Day of 4[J6Urj�— , 20jff
I'IBLIC
MICHAEL A. VJMACK
INOtary Public,State of New,York
No.02KI505682
ew=fed In Nassau County
ion Expires March 11„2022
10/1/2008 8
G. DISCLOSURE AFFIDAVIT
State of New York
County of Suffolk
wwel �m ,y6 1 �w,,,.being by me duly sworn, deposes and says
1. I am an a: for a project or an owner of the land which is the subject of a pending
application before the Southold Town Board for amendment and/or change of zone.
2. The project name is: _� �' _.�
3. I reside at
4. The Officers of the applicant corporation or owner corporation are as follows.
NAME TITLE
w
5. I make and complete this affidavit under the penalty of perjury and swear to the truth
herein.
6. I am aware that this affidavit is required by General Municipal Law 809 and that I shall
be guilty of a misdemeanor as provided by General Municipal Law 809 should I
knowingly or intentionally fail to make all disclosures herein.
7. During the 12 months before the filing of this application, have any of the following
individuals made campaign contributions exceeding $100 in total, in cash or in kind, to
members of the Town Board or political committees designated to accept donations
behalf:
Yes No
I. Owner X _
2. Applicant --X
3. Agent for owner or applicant _Ix
4. Attorney .—
_ --x
5. Other �
10/1/2008 6
If the answer to Question 7 is yes, Town Code Chapter 26 require that the information be
provided below:
Name Title (Owney A gent, Attdrrne otherl Amount
For the purpose of this disclosure, an official or employee or either the Town of Southold or the
County of Suffolk, shall be deemed to have an interest in the applicant and or owner when that
official or employee, their spouse, brothers, sisters, parents, children, grand children or the
spouse of any of them:
a. Is the applicant or owner
b. Is an officer, director, partner, or employee of the applicant or owner
c. Legally or beneficially owns or controls stock of a corporate applicant or owner,
or is a member of a partnership or association applicant or owner, or
d. Is a party to an agreement with the applicant or owner, express or implied,
whereby said official or employee may receive any payment or other benefit—
whether or not for services rendered, dependent or contingent upon the favorable
approval of such application.
Ownership of less than five percent of the stock of a corporation whose stock is listed on the
New York Stock or American Stock Exchanges shall not constitute an interest for the purposes
of this disclosure
YOU MUST ANSWER THE FOLLOWING QUESTION YES OR NO
Do any of the following individuals have an interest in the applicant or owner, as defined above?
._....._-YES X _. _...NO
1. Any official New York State YES `X NO
2. Any official or employee of Southold Town or Suffolk County? YES _�L_NO
If the answer above is yes, to any of the questions, General Municipal Law Section 809 requires
that you disclose the name and residence and the nature and extent of the Interest of said
individual (s) in the applicant or owner.
NAME RESIDENCE NATURE OF INTEREST
10/1/2008 7
.� :.
SIGNA :E
Sworn before me this .
Day of n � .a 2
Ry PUBLIC
TRACEY L. DWYER
NOTARY PUBLIC,STATE OF NEW YORK
NO.01 DW6306900
QUALIFIED IN SUFFOLK COUNTY
COMMISSION EXPIRES JUNE 30,2Q-2c')-
10/l/2008
0,2Q2c')-10/1/2008 8
Full Environmental Assessment Form
Part I -Project!and Setting
Instructions for Completing Part 1
Part 1 is to be completed by the applicant or project sponsor. Responses become part of the application for approval or funding,
are subject to public review, and may be subject to further verification.
Complete Part 1 based on information currently available. If additional research or investigation would be needed to frilly respond to
any item, please answer as thoroughly as possible based on current information; indicate whether missing information does not exist,
or is not reasonably available to the sponsor;and,when possible,generally describe work or studies which would be necessary to
update or fully develop that information.
applicants/:slaeaaasoa•s rnust complete all items in Sections A &B. In Sections C,D&E,most items contain an initial question that
roust be answered either"Yes"or"Nei", If alae answer to true initial question is"Yes",compietcthe sub-questions that follow. If the
a11swer to,the initial question is "No",proceed to the next question. Section F allows the project sponsor to identify and attach any
additional information. Section G requires the name and signature of the;project sponsor to verify that the information contained in
Part 1 is accurate and complete.
A.Project and Sponsor Information.
Name of Action or Projects -
Project Location(describe,and attach it general location map):
Brief Description of Proposed Action(include purpose or meed):
E�u� ZONE- CMA G� A-12 0A/ ,P— 4 ° 7-o
� N
S /V.e__
Name of Applicant/Sponsor: Telephone •� 7
E iL
Address: "'i
City/PO: State: Zip C de:
Project Contact if not same;as sponsor; �����--
J (' p , give name and title/role): Telephone:
E-Mail:
Address:
City/PO: State: p Zip Code:
Property Owner (if not same as sponsor): Telephone:
E-Mail:
Address:
City/PO State: z Cert
Page 1 of 13 RESET FORM
B.Government Approvals
B.Government Approvals Funding,or Sponsorship. ("Funding;"includes grants,loans,tax relief,and any other forms of financial
assistance.)
Government Entity If Yes. Identify Agency and Approval(s) Application Date
(Required (Actual or projected)
a.Ci Council Town Board Yes.':No Vii' rC C1a+.+4,P LOD
or Village Board of Trustees
b.City,Town or Village ❑Yes%No
Planning Board or Commission
c.City Council,Town or ❑YesXNo
Village Zoning Board of Appeals
d.Other local agencies ❑Yes No
e.County agencies ❑Yes No
f. Regional agencies ❑Yes No
g.State agencies ❑Yes0
h.Federal agencies ❑Yes;flNo
i. Coastal Resources.
_ w—
i. Is the project site within a Coastal Area,or the waterfront area.of a Designated inland Waterway? ❑YesjoNo
If Yes,
fl. Is the project site located in a community with an approved Local Waterfront Revitalization Program? 06Yes❑No
iii. Is the project site within a Coastal Erosion Hazard Area? ❑Yes%No
C. Planning and Zoning
C.I.Planning and zoning actions.
Will administrative or legislative adoption,or amendment of a plan„local law,ordinance,rule or regulation be thecs❑No
only approval(s)which must be granted to enable the proposed action to proceed?
• If Yes,complete sections C,F and G.
• If No,proceed to question C.2 and complete all remaining sections and questions in Part 1
C.2.Adopted land use plans.
a.Do any municipally-adopted (city,town,village or county)comprehensive land use plan(s)include the site Yes1J"N'o
p
where the proposed action would be located?
If Yes,does the comprehensive plan include specific recommendations for the site where the proposed action ❑Yes(gNo
would be located?
Iann
T
Brownfield Opport nity Area(BOA);des gnated State ogi r Fede alexam
'herpitage�ae a;watershed sfhed m nagement planay ®"'es No
or other?)
If Yes, identify the plan(s):
c Is or an adopted mue proposed nicipal faion red mland nd Ily or protection pla within an area listed m a adopted municipal open space plan, � 'es. No
If Yes, identify the plan(s):
Page 2 of 13 ZESET FORM
C.3. Zoning
a. Is the site of the proposed action located in a municipality with an adopted zoning law or ordinance. XYes❑No
If Yes, what is the zoning classification(s) including overlay district?
b. Is the use permitted or allowed by a special or conditional use permit? ' Yes❑No
c. Is a zoning change requested as part of the proposed action? XYes❑No
If Yes,
i. What is the proposed new zoning for the site? . .TI l,6-
CA. Existing community services.
a. In what school district is the project site located? 1 ^
b. Whatslice or other er public protection forces serve the project site'?
c. Which fire protection and emergency medical services serve the project site?
d. What parks serve the project site?
D.Project Details
D.I. Proposed and Potential Development
a. What is the general nature of the proposed action(e.g.,residential,industrial,commercial,recreational;if mixed, include all
components)?
b.a.Total acreage of the site of the proposed action? 4. acres
b.Total acreage to be physically disturbed? O acres
c.Total acreage(project site and any contiguous properties)owned
or controlled by the applicant or project sponsor? 0, _ acres
c. Is the proposed action an expansion of an existing project or use? ^� ( g ❑yg o
L If Yes what is theapproximate percentage of the proposed expansion and identifythe units(e.g.,acres miles housing units
square feet)? % Units:
d. Is the proposed action a subdivision,or does it include a subdivision? ❑YesJEONo
If Yes
i. Purpose or type of subdivision?(e.g.,residential, industrial,commercial; if mixed,specify types)
r�. ]s a t
clus... ..er/ .._ ._ ........ _. _
conservation layout proposed? ❑Yes o
iii. Number of lots proposed?
iv. Minimum and maximum proposed lot
' p p sizes? Minimum _ Maximum
e. Will proposed action be constructed in multiple phases? ll YesRF)
i. If No,anticipated period of construction: months
H. If Yes:
• Total number of phases anticipated _,_..
• Anticipated commencement date of phase 1 (including demolition) month year
• Anticipated completion date offinal phase month year
• Generally describe,connections or relationships among phases,including any contingencies where progress of one phase may
determine timing or duration of future phases:
Page 3 of 13 RESET FORM
IT,
Does the project include new residential uses?
If YsgNo
es,show numbers of units proposed.
One Family Two Family Three Family itdarltiile Fancily.four or morel
Initial Phase
At completion -�
of all phases
g. Does the proposed action include new non-residential construction.(including expansions)? Yew bio
If Yes„
i.Total number of structures
Dimensions
(in
feet)
of bui din sof pace to
height; width; and _length
iii. Approximate extentg p be heated or cooled: square feet
h. Doesish such asc creation of a water supply,reservoir,p pond,lake,wast'llagoonlor other storage?ment of any []Yes o
proposed P
e
If Yes,
i. Purpose of the impoundment: _
ii. If a water impoundment,the principal source of the water: t O.. __"
�] Ground water Surface water s—
P P P r.
treams ❑Other specify:
iii. If other than water, identify the type of impounded/contained Iic uids and their source,
I
iv.VP
proximate size of the proposed impoundment. Volume: _ g million gallons;s;surface
PP p e area: _ acres
v. Dimensions of the proposed dam or impounding structure height; length _. w....
vi. Construction method/materials for the proposed dam or impounding structure(e.g.,earth fill,rock,wood,concrete):
D.2. Project Operations
a.Does the proposed action include any excavation,mining,or dredging,during construction,operations,or both? Yes- No
(Not including general site preparation,grading or installation of 0tilities or foundations where all excavated
materials will remain onsite)
If Yes
i.What is the purpose of the excavation or dredging?
ii. How much material(including rock,earth,sediments,etc.)is proposed to be removed from the site?�
• Volume(specify tons or cubic yards):
• Over what duration of time?
a
iii. Describe nature and characteristics—of raaaterials to lie cxcavated or dredgz„d,arr_cl plans—
to use,rrr—
anage or dispose of them„
iv. Will there be onsite dewatering or processing of excavated mates,als?
If yes,describe. ❑Yes No
v. What is the total area to be dredged or excavated? acres
vi. What is the maximum area to be worked at any one time? "
. _ _ acres
vii. What would be the maximum depth of excavation or dredging? _Yy feet
viii. Will the excavation require blasting? � � []Yes;gNo
ix. Summarize site reclamation goals and plan:mm
Wou
b. into any existing wetlad the proposed nd,waterbody,action cause or shot in reline,alteration
l, beach or-adjacent area?increase or crease in size of,or encroachment �'es o
I'f Yes.
L Identify the wetland or waterbody which would be affected(by name,water index number,wetland map number or geographic
description):
Page 4 oi'13 RESET FORM
n. Describe how the proposed posed action would affect that waterbody or wetland,e.g.excavation, fill,placement of structures,or
alteration of channels,banks and shorelines. Indicate extent of activities,alterations and additions in square feet or acres:
ni WiYe r pose describe: cause or result in disturbance to bottom se ' ❑Yes N
dtments7 0
If
iv. Willro osed action cause or result i -..�,�.........qum_.w. � � ❑Yes N�o.. .
p p n the destruction or removal of a vatic vegetation?
If Yes:
• acres of aquatic vegetation proposed to be removed
• expected acreage of aquatic vegetation proposed to be remo,red
• purpose of proposed removal(e.g.beach clearing, invasive species control,boat access),
• proposed method of plant removal:
• if chemical/herbicide treatment will be used,specify product(s):
v. Describe any proposed reclamation/mitigation following disturbance
�. ..
c. Will the proposed action use,or create a new demand for water? ❑Yes 'o
If Yes:
i. Total anticipated water usage/demand per day:: �„
gallons/day
ii. Will the proposed action obtain wager from an existing Public water supply?
❑Yesp!gNo
If Yes:
• Name of district or service area:
Does the existing public water supply have capacity to serve thy,pr
• oposal? Yes❑No
• Is the project site in the existing district? OYesElNo
Is expansion of the district needed? ❑YesCffNo
• Do existing lines serve the project site? Yes❑No
iii. Will line extension within an existing district be necessary to supply the project? ❑YesMNo
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:.„
• ource(s)of supply for the district:
iv. Is a new water supply district or service area proposed to be formed to serve the project site? ❑YesNfNo
If,Yes:
• Applicant/sponsor for new district: _
• Date application submitted or anticipated:.
• Proposed source(s)of supply for new district: _
v. If a public water supply will not be used,describe plans to provide water supply for the project:_
Vi. If water supply supp ywill be from wells(public or private),maximum pumping capacity: gallons/minute.
d. Will the proposed action generate liquid wastes? ❑YesD§No
If Yes:
L Total anticipated liquid waste generation per day: gallons/day
ii. Nature of liquid wastes to be generated(e.g.,sanitary wastewater,industrial; if combination,describe all components and
approximate volumes or proportions of each):
iii. Will the ro osed
p p action use any existing public wastewater treatment facilities? ❑Yes o
If Yes:
• Name of wastewater treatment plant to be used:
• Name of district: _
Does the existing wastewater treatment plant have capacity to serve the_project? ❑Yes%No
• Is the project site in the existing district? ❑YesJ9rNo
• Is expansion of the district needed? ❑YesZNo
Page 5 of' 13 RESET FORM
• Do existing sewer lines serve the project site?
Yc NO
Will line extension within an existing district be necessary to serve the project? EJYesNo
If Yes:
• Describe extensions or capacity expansions proposed to serve this project:
rv. If'Y a new wastewater(sewage)treatment__� _.._...
district be formed to serve the project site? ❑Yes No
• Applicant/sponsor for new district:
Date application submitted or anticipated:
paled
•
What is the receiving water for tits w,astcaw ater ddsclaaage T
v. ]fpublic facilities will not be used,describe plans to provide%wstewater treatment far the project, including s c�cif�yura g proposed
osed receivingwater(nal and classification of surface
discharges,or describe subsurface disposal plans'
plans or designs to capture,recycle or reuse liquid waste:
vi. Describe any
e Will the sources proposed
e, posed sction disturb more than one acre and create slormwater runoff,either from new point mm ❑Ye
s o
( g
pipes,swales curbs utters or other concentrated flows of stormwater)or non-point
source(i.e.sheet flow)during construction or post construction`'
If Yes:
i. How ruarcla isaalaervioaNs srarliace wall tlae project create in relation to total size of project parcel?
Square feet or _..acres(impca-vious surface)
Square feet or acres(parcel size)
ii. Describe types of new point scaurces.
tet. Whe._.... ..�
re will the stormwater runoff be directed(i.e,on-site stormwater management facility/structures,adjacent properties,
groundwater,on-site surface water or off-site surface waters)?
If to surface waters, identify receiving water bodies or wetlands:
ill
er runoff
ow to adjacent
`roposed antminim minimize impervious surfaces use pervious materials or c E]YeslNo
No
f. Does proposed p collect and re-use stormwater7 ❑Yes
the proposed action include,or will it use on-site,one or more sources of air emissions,including fuel ❑Ye; No
combustion,waste incineration,or other processes or operations?
If Yes, identify:
i.Mobile sources during project operations(e.g.,heavy equipment;,fleet or delivery vehicles)
U. Stationa sources dun .m.—
_ g ( g.,power eneratior structural heating batch plant c
ry n construction e. g :rushers) _
iii. Stationary sources during operations(e.g.,process emissions, large boilers,electric generation)
g. Will any air emission sources named in D.2.f(above),require a Na State Air Registration,Air Facility Permit, ❑Yes No
or Federal Clean Air Act Title IV or Title V Permit?
If Yes:
i. Is the project site located in an Air quality non-attainment area? (Area routinely or periodically fails to meet ❑YesJXNO
ambient air quality standards for all or some parts of the year)
ii. In addition to emissions as calculated in the application,the project will generate:
• _ Tons/year(short tons)of Carbon Dioxide(C:OZ)
•
--Tons/year(short tons)of Nitrous Oxide(NZO)
• _ Tons/year(short tons)of Perfluorocarbons(PFCs)
• _ Tons/year(short tons)of Sulfur Hexa.fluoride(3F6)
• _ Tons/year(short tons)of Carbon Dioxide equivalent of Hydroflourocarbons(.HFCs)
• _ Tons/year(short tons)of Hazardous Air Pollutants(HAPs,)
Nage 6 of 13 F ESET FORM
h.Will the'proposed action generate or emit methane(including, but not limited to sewage treatment plants, ❑ycs
P P g (� g, io
landfills composting facilities)?
If Yes:
rr. Describe any methane,capture,control or elimination measures ,combustion
i. Estimate methane generation in tons/ ear metric _
easures included in project design e. n
P ) g ( g• to generate heat or
electricity, flaring):
i illlrproposed
operations?
ctireIt in the release of air pollutants from open-air operations or processes,such as ❑YcsfXNo
quarry or
If Yes: Describe operations and nature of emissions(e.g.,diesel exhaust, rock particulates/dust):
J Will
transresult
n facilitiesservices?
,ititor increase in traffic above present levels or generate substantial ❑ N
Yes o
new demand for portat o
If Yes-,
i. When is the peak traffic expected(Check all that apply): ❑Morning ❑ Evening ❑Weekend
❑ Randomly between hours of� to
ii. I"or commercial activities only,projected nuinber of senii-trailer truck.trips/day:
iii. Parking spaces. Existing_._—� _._ Proposed Net increase/dccrerssc _
iv. Does the proposed action include any shared use parking'? ❑Yc s o
v. Irthe proposed action includes an, modification of existing roads,creation of new roads or clumige in existing access,describe:
tlr / r it —1i ties avai I'a—ble
r ' noproposed site? 2Y—esIT[fWN--o""---
vii Will heProPsed action include access to public transportation or accommodations r use of hybrid,electric Ye No
or other alternative fueled vehicles?
viii.Will the proposed action include plans for pedestrian or bicycle accommodations for connections to existing ❑Yes%No
pedestrian or bicycle routes?
k ill the proposed? action(for commercial or industrial.projects only)generate new or additional demand ❑Yes No
f
If Yes:
i. Estimate annual electricity demand during operation of the proposed action:
H. Antra ated-sources/sup-pliers Tiers of electrics for the project e. or
�P 1 P ty p � ( g., .r-site combustion,on-site renewable,via grid/loca]utility,or
other):
Will the proposed action require a new,or an upgrade:to,an existing substation? ❑Yes�No
1. Hours of operation. Answer all items which apply.
L During Construction: ii. During Operations:
• Monday-Friday: _ • Monday-Friday:.
• Saturday: _ Saturday:
• Sunday: 0 Sunday:
• Holidays: �— Holidays: ..
Page 7 of 13 RESET FORM
m. Will the proposed action produce noise that will exceed existing ambient noise levels during construction, ®Yes No
operation,or both.
If yes:
i. Provide details including sources,time of day and duration:.
u. Will proposed•� p p action remove existing natural barriers that could act as a noise barrier or screen. �
❑Yes No
Describe:
n.. Will the proposed action have outdoor lighting? ❑YesNo
If yes:
L Describe source(s), location(s),height of fixture(s),direction/aim,and proximity to nearest occupied structures:
ii. Wil pro ion rem l
proposed actremove existing natural barriers that could act as a � �ri��.����
light barrier or scree ❑Yes No
Deso. Does the proposed action have the potential to produce odors
for more than one hour per day? ❑Yes o
If Yes,describe possible sources,potential frequency and duration of odor emissions,and proximity to nearest
occupied structures:
P Will P action 85ncany t� g—of Pra (,ombined caKaci h
of over 1 ❑Yes ho,100 gallons)chemical Poducts( gallons n above ground storage or an amount in underground storage)?
If Yes:
i. Product(s)to be stored
) per unit time— ..... .� _. —.—
U. Volume(s _ (e.g.,month,year)
iii. Generally describe proposed storage facilities:
q.Will the pro)osed action(commercial,, industrial and recreational projects only)use pesticides(i.e.,herbicides, ❑Yes No
insecticides duringconstruction oro operation?
If'Yes
L Describe proposed treatment(s):
H. Will the ro oscd action use Inte ratedr est Mana ernent PractF
p P ( ices? ❑ Yes No
r.of solid
the proposed action commercial or industrial projects only)involve or require the management or disposal El Yes No
olid waste(excluding hazardous materials)?
If Yes:
L Describe any solid waste(s)to be generated during construction or operation of the facility:
• Construction: . — tons per (unit of time)
• Operation : _ tons per_ (unit oftime)
H. Describe any proposals for on-sate minimization,recycling or reuse of materials to avoid disposal as solid waste:
• Construction:
• Operation.
._
iii. Proposed disposal methods/facilities for solid waste generated on.-Site: IT m
• Construction:
• Operation:
—.�.._
Page 8 o.
f 13 �RESET FORM
s. Does the proposed action include construction or modification of-as-olid waste management facility? n Yes 1A No
If Yes;
i. Type of management or handling of waste proposed for the sit(:(e.g., recycling or transfer station,composting,landfill,or
other disposal activities):
na Anticipated rate of disposal/processing:
P �._ .. _.�.....—.,mm_m......... ...
• Tons/month, if transfer or other non-combustion/thermal treatment,or
• Tons/hour,if combustion or thermal treatment
iii. If landfill, anticipated site life:_ years
t. Will rprth
proposed action at the site involve e commercial generation,treatment,storage,or disposal of hazardous (:YestZNo
If Yes:
i. Name(s)of all hazardous wastes or constituents to be generated,handled or managed at facility:
ii. Generally describe processes or activities involving hazardous wastes or constituents:
p g r constituents:
in. Specify amount to be handled
P fY o
r generated � tons/month
iv. Describe any proposals for on-site;minimization, recycling or reuse of hazardous constituents:
v. Will any hazardous wastes be disposed at an existing offsite hazardous waste facility? ❑YesNo
If Yes: provide name and location of facility:
If No: describe proposed management of any hazardous wastes which will not b
e sent to a a hazardous waste facility:
E.Site and Setting of Proposed Action
E.I.Land uses on and surrounding the project site
a.Existing land uses
i. Check all uses that occur on,adjoining and near the project site.
❑ Urban ❑'' Industrial Commercial ❑ Residential(suburban) ❑ Rural(non-farm)
❑ Forest ❑ Agriculture ❑ Aquatic ❑ Other(specify):_
ii. If mix of uses,generally describe:
b.Land uses and covertypes on the project site. _
Land use or Current Acreage After Change
Covertypae Acreage Project Compleflorr (Acres
• Roads,buildings,and other paved or impervious
_ surfaces
• Forested 0 -
• Meadows,grasslands or brushlands(non-
,
non- O
agricultural„including;abandoned,agr'icultural)
Agricul
includetural s O
active orchards, field,,greenhouse etc.)
• Surface water features O
(lakes,ponds,streams,rivers,etc.)
• Wetlands(freshwater or tidal)
Non-vegetated(bare rock earth or fill)
• Other
Describe:
Page 9 of 13 RESET FORM
C. Is the project site presently used by members of the community for public recreation? ElYcs �N——0
i. If Yes:explaiw
d.Are there any facilities serving children,the elderly,people with disabilities(e.g.,schools,hospitals,licensed ❑YCSXNo
day care centers,or group homes)within 1500 feet of the project site?
If Yes,
i. Identify Facilities:
e.Does the project site contain an existing dam?
If Yes:
i. Dimensions of the dam and impoundment:
Dam height: feet
0" Dam length: feet
Surface area: acres
Volume impounded: gallons OR acre-feet
U. Dam's existing hazard classification:
W. Provide date and summarize results ji—ast"inspection:
............
f. Has the project site ever been used as a municipal,commercial o.r industrial solid waste management facility, []Ycs%No
or does the project site adjoin property which is now,or was at one time,used as a solid waste management facility?
If Yes:
1. Has the facility been formally closed? [:]Yes❑ No
* If yes,cite sources/documentation:
ii. Describe the location of the project site relative to the boundaries of the solid waste management facility:
ifl. Describe any development—constraints—due to the—prior solid waste activities:
g.Have hazardous wastes been generated,treated and/or disposed of at the site,or does the project site adjoin ®Yes No
property which is now or was at one time used to commercially treat,store and/or dispose of hazardous waste?
If Yes:
i. Describe waste(s)handled and waste management activities, including approximate time when activities occurred:
h. Potential contamination history. Has there been a reported spill at the proposed project site,or have any E1YcJ4 No
remedial actions been conducted at or adjacent to the proposed s'ite?
If Yes:
i. Is any portion of the site listed on the NYSDEC Spills Incidents database or Environmental Site E]YesgNo
Remediation database? Check all that apply:
El Yes—Spills Incidents database Provide DEC ID number(s):
0 Yes—Environmental Site Remediation database Provide DEC ID number(s):
0 Neither database
ii. If site has been subject of RCRA corrective activities,describe control measures:_,
iii. Is the project within 2000 feet of any site in the NYSDEC Environmental Site Remediation database? ❑YeslgNo
If yes,provide DEC ID number(s):
iv. If yes to or(iii)above,describe Current status of site(s):
Page 10 of 13FtESET FORM
V. Is the project subject to a � -��-...� ..
p J J n institutional control limiting property uses? ❑Yeslk
If yes DEC site ID number:
Describe the type of institutional control (e.g.,deed restriction or easement):
.. mm
• ent)•
• Describe any use limitations:
�..._.
• Describe any engineering controls _
Will the project affect the institutional or engineering'oi----e. w.�...——®.�� .—.� "
• p J controls in place? ❑Yeo o
• Explain: _
E.2. Natural Resources On or Near Project Site
_ �...... _-mm
e
a. What is the d
—average �
epth to bedrock on the project site? Meet
If Yes,whatproportionof the site is comprised pof bedrock -
bedrock outcroppingsv .. _
b.Are there bedrock outcro in s on the r J _ite? - -'" mm -'
❑Yes i�lo
c.Predominant soil type(s)present on project site:
d. What is the average depth to the water table on the project site? Average: feet
e.Drainage status of project site soils:❑ Well Drained: %of site
5ff Moderately Well Drained: M—%of site
❑ Poorly Drained %of site
- �_ �._... ❑ 1-10%: Jd2%of site
£Approximate proportion of proposed action site with slopes: 0-]0%: %of site
❑ 15%or greater: %of site
g.Are there any unique geologic features on the project site?
describe:If Yes, Yes'
h.Surface water features.
i, Does any portion of the project site contain wetlands or other waterbodies(including streams,rivers, ❑YesN�No
ponds or lakes)?
A Do any wetlands or other waterbodies adjoin the project site? ❑YesNfNo
If Yes to either i or ii,continue. If No,skip to E.2.i.
iii. Are any of the wetlands or waterbodies within or adjoining the project site regulated by any federal, ❑YesMo
state or local agency?
iv. For each identified regulated wetland and waterbody on the project site,provide the following information:
• Streams: Name Classification
• Lakes or Ponds: Name Classification
Wetland No.(if regulated.
• Wetlands: Name Approximate Size
• ( g by DEC)_ .
v. Are any of the above water bodies listed in the most recent compilation of NYS water quality-impaired ❑Yes;Io
waterbodies?
If yes,name of impaired water body/bodies and basis for listing as impaired:
.���
i.Is the project site in a designated Floodway?
❑Yeso
j. Is the project site in the 100 year Floodplain? ❑Yes No
'—
k. Is the project site in the 500 year Floodplain?
EllYcs o
I. Is the project site located over,or immediately adjoining,a primary,principal or sole source aquifer? El Yes CZNo
If Yes:
i. Name of aquifer:
Page 1 1 of 13 RESET' FORM
predominant wildlife s ewes that �e��roice;t site,
M. Identify the p p at occu or use th
PY
n. ro contain the Docs project site �
' p j nin a designated significant natural community? ❑Yc-so i�'®
If Yes:
i. Describe the habitat/community(composition,function,and basis for designation): _
H. Sources of __
description or evaluatio
W. Extent of community/habitat:
• Currently: acres
• Following completion of project as proposed acres
• Gain or loss(indicate+or-): acres
o.Does project site contain _ i -r" y g —_ ❑
p ) any species of plant or animal that is listed b the federal ovemment or NYS as Ye.., No
endangered or threatened,or does it contain any areas identified as habitat for an endangered or threatened species?
Does the w ject _..
p site contain any species of plant or animal that is listed by NYS as rare,or as a species of
specialone — �YesNo
�..
q.Is the project site or adjoiningarea currently used for hunting,.trapping,CorIfishinghin'6 or shell fshing�• ❑Ycs'It�oIf es, a brief description of how the proposed ._
.__.�
action may affect that use:
E.3. Designated Public Resources On or Near Project Site
a. Is the project site,or any portion of it, located in a designated agricultural district certified pursuant to ❑Yes " No
Agriculture and Markets Law,Article 25-AA, Section 303 and 304?
If Yes, provide county plus district name/number:
b.Areagricultural lands
project consisting productive soils present? ❑Yes No
H. Source(s)of soil rating(s):
-- —
Does the project
c e contain all or part of,or is it substantially contiguous to,a registered National _ ❑Yes No
Natural Landmark?
If Yes:
i. Nature of the natural landmark: ❑Biological Community ❑ Geological Feature
fl. Provide brief description of landmark, including values behind designation and approximate size/extent:
d. Is she project site located in or does it adjoin a state listed Critical Environmental Area? ❑Ycs No
If i. CEA name:
ii. Basis for desi nation:
.. � _.._
W. Designating agency and date:
Page 12 -of 13 RESET FORM
Does
he
te
ain,or is it
e which s l project
d on,ror hastbeen nominated bytheNYStBoardsbuilding,archaeological
of Hi toriPrre ervation for nclusion on, ®Y e
the ' No
State or National Register of Historic Places?
If Yes:
L Nature of historic/archaeological resource: ❑Archaeological Site []Historic Building or District
ii. Name:
iii. Brief description......
of attributes on which listing is based:
f. Is thero'ect site .._w._.��.�._W_ __.......
p or any portion of it, located in or adjacent to an area designated as sensitive for ❑acs No
archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory?
g.Have additional archaeological or historic sites or resources been identified on the r
� g� � O project site? J–lYes �No
If Yes:
i. Describe possible resource(s): „
ii. Basis for identification:
h. Is the project site within five miles of an officially designated
P j � y y g d ar.�d publicly accessible federal,state,or local
scenic or aesthetic resource? r
If Yes: _ � � ..� �i4r�VD//1��s pi�i�IC
i. Identify resour°ce
J'or�NDY/SGV DUNES f�J�Pk, C O/�J� ,�
ii. Nature of,or basis for,designation(e.g established highway overlook,st;,yte or local park,state historic trail or scenic bywEay,
iii. Distance between project and res _ n
etc. :
ource: miles.
i. Is thero ect site located within a designated river corn
P j g dor under the Wild,Scenic and Recreational Rivers M—yesp<No
Program 6 NYCRR 666?
If Yes:
L Identify the name of the river and its designation:
ii. Is the activity consistent with development restrictions contained in 6NYCRR Part 666 Yes No
F.Additional Information
Attach any additional information which may be needed to clarify your project.
If you have identified any adverse impacts which could be associated with your proposal,please describe those impacts plus any
measures which you propose to avoid or rninimize them.
C. Verification
I certify that the information provided is true to the best of my knowledge.
Applicant/SponsorNime _-,4 -A�7H
4jC, _ Dtrte "� "
Sig�natureug—
"r Titleljj(,j�%
PRINT FORM Page 13 of 13 ER�ETFORM
Full Enviro momra/Assessment Form
Por 2-I/cn/ifico/ionmo(Po&nz/iad Impacts
Part is to bccompKete(I by tile \oud og*ncy. Part 2 is designed to help the lead agency |nvonioryu|{ potential resourcethat nmo|d
be affected by uproposed project or$mdcm. \uorecognize that the}omd u8enoy^urevymvvmr(o)vv|}| not necessarily be environmental
professionals, 8o,thogucm1[amsurodmmigmodtmvva|kmxeviuvverthrmughdhonsaossmmntp' emshyproviding useries uyguomdmnmthat
can hoanswered using the information found inPart |. T'nfurtherasoiot the lead agency incompleting Part 2'the form identifies the
most relevant questions inPail \ that will provide the information needed toanswer the Part 2question. When Part 2iocompleted,the
lead agency will have identified the relevant environmental area*that may heimpacted hythe proposed activity.
If the lead agency is a state agency and the action is in any Coastal Area,complete the Coastal Assessment Form before proceeding
with this assessment.
Tips for completing Part 2:
° Review all ofthe information provided inPart l.
° Review any application,maps,supporting materials and the Full BAF Workbook,
° Answer each o[the i8questions inPart 2. �
° If you answer"Ves"to a numbered question,please complete all the questions that follow in that section.
° If you answer"No"to a numbered question, move on to the next numbered question.
° Check appropriate column toindicate the anticipated size ofthe impact,
° Proposed projects that would exceed a numeric threshold contained in a question should result in the reviewing agency
checking the box"Moderate tolarge impact may ouuur."
° The reviewer isnot expected tohounexpert inenvironmental analysis.
° lyyou are not sure orundecided about the size ofunimpact, itmay help toreview the sub-questions for the gcnum|
question and consult the workbook.
° When answering uquestion consider all components uCtheproposed activity,that is,the"whole uoLion"
° Consider the possibility for long-term and cumulative impacts uowell aadirect impacts.
° Answer the question in a reasonableconsidering hscale
Imp act on Land
Proposed action may involve construction on, or physicall alteration of,
the land surface of the proposed site. (See Part 1. D.1) %NO YES
es", answer questions a-j, ff"No move on to 3ection 2,
f4, elevant No,or Moderate
Part
small to large
Question(s) impact impact may
a.The proposed action may involve construction on land where depth to water table is aa_y_0Hc_Ur_
less than 3 feet. E2d El
b.The proposed action may involve construction on slopes of 15%or greater, E2f D D
c.The proposed action may involve construction on land where bedrock is exposed,or E2a El El
generally within 5 feet of existing ground surface. I
d.The proposed action may involve the excavation and removal of more than 1,000 tons D2a El 11
of natural material.
e.The proposed action may involve construction that continues for more than one year Dle
in mult. le phases. 1:1 El
f.The proposed action may result in increased erosion,whether from physical D2e,D2q El
disturbance or vegetation removal(in�ludi
g. The proposed action is,or may be, located within a Coastal Erosion hazard area. Bli
El El
h.Other impacts- El El
Page lofl0 DES,ET FORM
... _
2. Impact on Geological Features
The proposed action may result in the modification or destruction of, or inhibit
access to, any unique or unusual land forms on the site(e. ., cliffs, dunes, XNO ❑YES
minerals, fossils,caves). (See Part 1. E.2.g)
ff
-�-
es", answer questions rr c. l' ��.. ,�..
�No move on to Section 3. Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
, ma occur occur
a. Identify the specific land forms)attached: Egg
b.The proposed action may affect or is adjacent to a geological feature listed as a E3c ❑ ❑
registered National Natural Landmark.
Specific feature:
c. Other impacts: LL ❑ ❑
3. Impacts on Surface Water
The proposed action may affect:one or more wetlands or other surface water ONO ❑YES
bodies(e.g., streams,rivers, ponds or lakes). (See Part 1. D.2, E.2.1i)
""Yes", answer rwestr'ons a-C. / "No"„ move on to Section 4.
Relevant No,or Moderate
ha. �r Part I small to large
�
Question(s) impact impact may
w ,
r: L
°'� �r. "° �� . .� .� �": may occur occur
a.The proposed action may create a new water body. 132b,D1h ❑ ❑
b.The proposed action may result in an increase or decrease of over 10%or more than a D2b ❑ ❑
10 acre increase or decrease in the surface area of any body of water.
c.The proposed action may involve dredging more than 100 cubic yairds of material D2a ❑ ❑
from a wetland or water body.
d.The proposed action may involve construction within or adjoining a freshwater or E2h ❑ ❑
tidal wetland,or in the bed or banks of any other water body.
e.The proposed action maty create turbidity in a waterbody,either from upland erosion, D2a,D2h p ❑
runoff or by disturbing bottom sediments.
£The proposed action may include construction of one or more intake(s)for withdrawal D2c ❑ ❑
of water from surface water.
g.The proposed action may include construction of one or more outfall(s)for discharge D2d ❑ ❑
of wastewater to surface water(s).
h.The proposed action may cause soil erosion,or otherwise create a source of D2e ❑
stormwater discharge that may lead to siltation or other degradation of receiving
water bodies.
i.The proposed action may affect the water quality of any water bodies within or E2h ❑ ❑
downstream of the site of the proposed action.
j.The proposed action may involve the application of pesticides or herbicides in or D2q,E2h E) 171
around any water body.
k.The proposed action may require the construction of new,or expansion of existing, DI a,D2d ❑ I
wastewater treatment facilities.
Page 2 of"10
RESET FORM
I.Other impacts: ❑,
4. Impact on groundwater
The proposed action may result in new or additional use of ground water, or gNO ❑YES
may have the potential to introduce contaminants to ground water or an aquifer.
(See Part 1. D.2.a, D.2.c, D.2.d, D.2.p, D.2.q, D.2.t)
1j "Yes answer cir.res°tion,s a-h. j`"No", move on to Section S.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
rpay occur occur
a.The proposed action may require new water supply wells,or create additional demand D2c ❑
on supplies from existing water supply wells.
b. Water supply demand from the proposed action may exceed safe:and sustainable D2c ❑
withdrawal capacity rate of the local supply or aquifer.
Cite Source:
c.The proposed action may allow or result in residential uses in areas without water and D 1 a,1D2c
sewer services.
d.The proposed action may include or require wastewater discharged to groundwater. D2d,E21� ❑
e.The proposed action may result in the construction of water supply wells in locations D2c,Elf,
where groundwater is,or is suspected to be,contaminated. EIg,Elh
f.The proposed action may require the bulk storage of petroleum ar chemical products 132p,E-21 ❑
over ground water or an aquifer,
g.The proposed action may involve the commercial application of pesticides within 100 E2h,D2q, '� ❑
feet of potable drinking water or irrigation sources. E21,D2c
h. Other impacts: ❑
5. Impact on Flooding
The proposed action may result in development on lands:subject to flooding. VNO ❑YES
(See Part 1. E.2)
___ If,"Yes answer a r�est�oias a �1 "No", move on to 5e<tion 6
dg ,d y,, 9 d ap a" n Y. µ'W a ?+""—"""'""" 3. "� ^ tl h .,,v N .....—.,... �
x *` Relevant )`10,or Moderate
e Part I small to large
g
Questions impact impact may
•;�.��.� '^d� ��°; a� �,�n�;;�r� vTM� '�"'v �iw gp "' r ^,��"��}A`�p�"�""` �;� � .����r M �7 d��� P p y
ma' occur occur
a.The proposed action may result in development in a designated floodway. E2i ❑'
b.The proposed action may result in development within a 100 year floodplain. E2j ❑ El
c.The proposed action may result in development within a 500 year floodplain. E2k ❑ ❑
d.The proposed action may result in,or require,modification of existing drainage D2b, D2e ❑ ❑
patterns.
e.The proposed action may change flood water flows that contribute,to flooding. D2b,E2i, ❑ ❑
f. If there is a dam located on the site of the proposed action,is the dam in need of repair, E 1 e ❑ ❑
or to grade?
Page 3 of 10
F;ESETFORM
9.Other impactsP --
El
IF6. Impacts on Air
The proposed action may include a state regulated air emission source. RANO [:]YES(See Part 1. D.2.f., D,2,h, D.2.g)
Yes", answer erre„s•tions a - If`"No”, move on to Section 7.
Relevant No,or.. Moderate
' Part I small to large
t
Question(s) impact impact may
rra '.occur occur
aa. If thaw proposed action requires fcderal or state:air ermission permits,tile action may
also ernit one or more greenhouse gases at or above the followimIg levels:
i, More than 1000 tons/year of earbon dioxide(CO2) D2g ❑ ❑
ii, More than 3.5 trans/ycaar ofnitrous oxide(N20) D2g ❑ ❑
kL More than 1000 tons/year of carbon equivalent of perfluorocarbons(pj,r,Cs) D2g ❑ ❑
lv, More than .015 Wnslyearofsulfur hexaf9uoride(SFr,) D2 ❑ ❑
v. More than 1000 tains/year of carbon dioxide equivalent of D2g ❑ ❑
hydrochlorcallourocarbons(HFCs)ernissions
vi 43 tains/ycaar Or r`noa•c of methane D2h ❑ ❑
b.The proposed action may generate 10 tons/year or more of any on:e designated D2g ❑ ❑
hazardous air pollutant,or 25 tons/year or more of any combination of such hazardous
a' pollutants.
air l��o
c.The rate o _ _
proposed
total ontaminants that action may require
may exceed air registration,or may produce an emissions
D2f,D2g ❑ --
ed 5 lbs.per hour,or may include a heat El
source ca gable of proaluciarg more than 10 million BTU's per hour.
d.The proposed action may reach 50%of any of the thresholds in"aa"through"c", D2g ® ❑
above.
e.The proposed p p action
may result in the combustion or thermal treatment of more than 'I D2s
ton of refuse ver hour.
f.Other impacts: � ❑ ❑
7. Impact on Plants and Animals
The proposed action may result in a loss of flora or fauna. (See Part 1. E.2, m.-q.) 1KN0 ❑YES
If
of��� �'� a fpr �r • � a ��'�°
Yes answer rr staves a l No move on to SecVton 8. Relevant No,or Moderate
a;
tar �,. ,, Part I small to large
Question(s) impact impact may
G'na}occur occur
proposed y tion in population or loss of individuals of any Ego ❑� ❑
a.The ro osed action may cause reduction
threatened or endangered species,as'listed by New York State or the Federal
government,that use the site or are found on,over, or near the site.
b.The proposed action may result in a reduction or degradation of ani,habitat used by E2o ❑ ❑
any rare,threatened or endangered species,as listed by New York State or the federal
��overnm en t.
c.The proposed action may cause reduction in population,or loss of individuals,of any E2p ❑ ❑
species of special concern or conservation need as listed b New York State or the
Federal government,that use the site,or are found on,over,or near the site.
d.The proposed action may result it)a reduction or degradation of any habitat used by E2p ® ❑
any species of special concern and conservation need,as listed by New York State or
the Federal governnrant
...............
Page 4 o1710
RESET FORM
e.The proposed action may diminish the capacity of a registered National Natural E3c
Landmark to sup C munity it was establish(
111PP1111 Ile bilo-1110 al com____ .........
ItIo_Mo1Cr!.'_
f The proposed action may result in the removal of,or ground dislurbance in,any E2n El
portion of a designated significant natural community.
Source:
g.The�ro�osed action may substantially interfere with nesting/brceding, foraging,or
over-wintering habitat for the predominant species that occupy or use the project site. E2rn El
h.The proposed action requires the conversion of more than 10 acres of forest, E)
grassland or any other regionally or locally important habitat. Elb
]1 abitat type& information source:
i. Proposed action(commercial,industrial or recreational projects,only) involves use of D2q
herbicides or pesticides.
j.Other impacts� El
S. Impact on Agricultural Resources
The proposed action may impact agricultural resources. (See Part 1. E.3,a. and b.) 9TN0 YES
','Yes", answ,er,m move on to Section 9.
R�Ievant or Moderate
Part I small to large
Question(s) impact
impact may
inaL2L(:u
_r occur
a.The proposed action may impact soil classified within soil group I through 4 of the E2c,E3b 0 El
NYS Land Class if!cation
b.The proposed action may sever,cross or otherwise I im it access to agricultural land Ela,Elb 0
0
c.The proposed action may result in the excavation or compaction of the soil profile of E3b 1:1
act Icultural land. 3
d.The proposed action may irreversibly convert agricultural land to rion-agricu I turn] Elb,E3a 11 El
uses,either more than 2.5 acres if located in an Agricultural District,or more than 10
acres,if not within an Agricullural District,
e.The proposed action may disrupt or prevent installation of an agricultural land El a,E.1b 13 n
___Lllanaq�*ment system.
f.The proposed action may result,directly or indirectly, in increased development C2c,C3, 11 11
_20—tent !ure opJartntand. D2c,D2d
g.The proposed project is not consistent with the adopted municipal Farmland C2c 0 El
Protection Plan.
h.Other impacts:
Page 5 of 10 SET F�ORM�
9. Impact on Aesthetic Resources ...
P u rces
The land use of the proposed action are obviously different from, or are in WO YES
sharp contrast to, current land use patterns between the proposed project and
a scenic or aesthetic resource. (Part I. E.I.a,E.l.b, E.3 h.)
. k "Yes"answea- ! `No°° 7o to Section ltd
Relevant No,or Moderate
". Part I small to large
Question(s) impact impact may
may occur
occur
a. Proposed action may be visible from any officially designated federal,state,or local E3h ❑ ❑
scenic or aesthetic resource.
b.The proposed action may result in the obstruction,elimination or significant E3h,C2b ❑ []
scMeilingof one or ffi_ r ore ocially desigaaatc l'scenic views. _
1,o
c.The proposed action nuay be visible:from publicly accessible vantage,point
s: E3h
i. Seasonally (e. ., screened b summer folirt a but visible during other seasons) ❑ ❑
ii. Year round ❑ ❑
d.The situation or activity in which viewers are engaged while viewing the proposed 'E3h
action is:
i. Routine travel by residents, including travel to and from work E2q'
ii. Recreational or tourism based activities Elc 0 ❑
e.The proposed action may cause a diminishment of the public enjoyment and TDla,
3h [] ❑
appreciation of the designated aesthetic resource.
f. 'There are similar projects ro'ects visible within the following distance
e of the proposed Ela, El
project: Dlf,Dlg
0-1/2 mile
%:-3 mile
3-5 mile
5+ mile
g.Other impacts:
❑ ❑
10. Impact Historic
and Archeological Resources
The proposed posedn may occur in or adjacent to a historic or archaeological �NO a YES
resource. (Part 1. E.3.e, f. and.g.)
( "Yes"„ answer questions a-e. "No", go to Section LI.
N-
' 17" Relevant
o,or Moderate
t* ; Part I small to large
Question(s) impact impact[nay
r a
nayoccur
occur
a.The proposed action may occur wholly or partially within,or substantially contiguous E3e ❑
to,any buildings,archaeological site or district which is listed on or has been
nominated by the NYS Board of Historic Preservation for inclusion on the State or
National Register of Historic Places.
b.The proposed action may occur wholly or partially within,or substantially contiguous E3f ❑ ❑
to,an area designated as sensitive for archaeological sites on the NY State Historic
Preservation Office(SHPO)a achacolcagicral site inventory.
c.The proposed action may occur wholly or partially within,or substantially contiguous E3g p ❑
to,an archaeological site not included on the NY SHF10 inventory.
Source:
Page 6 of 1(I
RESET FORM
d.Other impacts: El
e.if anyof the above a-d are answered Yes',continue with the
( ) following questions
to helpsupport conclusions in Part 3:
i. The proposed action may result in the destruction or alteration of all or part De, E3 ❑ ❑
of the site or property, g'
E3f
ii. The proposed action may result in the alteration of the property's setting or E3e,EH, ❑ 1
integrity.
E3g,.Ela,
Elb
iii. The proposed action may result in the introduction of visual elements which De,1--3f, El
are out of character with the site or property,or may alter its setting. E3g,133h,
C .3
I. Impact on Open Space and Recreation .
The proposed action may result in a loss of recreational opportunities or a �NO JES
reduction of an open space resource as designated in any adopted
municipal open space plan.
(See Part 1, C.2.c, E.I.c., E.2.q.)
- _ Section 12,
r; r rL x s '�'" F No��n..,��G?'to ,.�.�., r Want �..�.._.;ds answer yestions as e. Rele 10,or)�"r'A Part I smallQuestions) impacta.Tlaeo result iia ata ornpawrraairt ofiaalural functiorr , or`°ecos s tr�a ot�.eurterra D2e,EI I rased action nra y .lb ❑ El
services",provided by an undeveloped area, including but not limited to storrnwater E2h,
storag41
e,nutrient cycliaag,wildlife habitat. E2m,E,2o,
E2n E2
b.The proposed action may result in the loss of a current or future recreational resource. !C2
Elc, ❑ ❑
:2'1
c.The proposed action may eliminate open ace or
recreational P p oral res�urce in an area C2c11
with few such resources. E?q
d.The proposed action may result in loss of an area now used informally by the El c
13
community as an cera space resource. ❑
e. Other impacts: ® ❑
12. Impact
Thproposed action may be to ental Ar n or ad
'�acent to a critical �NO YES
environmental area(CEA). (See Part 1. E.3.d)
T "`Yes , answer to stions ai c, No�r�
n, P o to Section Iii
a,
Relevant No,or Moderate
Part I small to large
Questions) impact impact may
" rraap occur occur
proposed m the quantity of the , w
a.The ro osed action may result in a reduction ' q y e resource or E3d
characteristic which was the basis for designation of the CEA.
Fheetd..waion may result in a reduction in the quality of the resource or E3dch was the basis for designiatirn of the CEA.
mm ❑
Page 7 of 10
=
-S�FO
RE
13. Impact on Transportation
The proposed action may result in a change to existing transportation systems, �NO YES
(See Part 1. D.2.j)
__,.. e stions a g to Section .14
" s ', answer��
Relevant No,or Moderate
Part I
small to large
Question(s) impact impact may
-------------
_.. I _ �. _ Y xceed calaacity of"eisgi��g road network. �. r�i occur occur
a Pro cctccl traffic increase anaz e
D2j D []
b.The proposed action may result in the construction of paved parking area for 500 or D2j
more vehicles.
proposed El ❑
c.The ro osed action will degrade existing transit access. D2j
proposed p action will degrade Existing pedestrian or bicycle accommodations. D2j �❑ []
dµThe p ro �
e.The proposed action may alter the present pattern of movement of people or goods. D2j ❑ 11
f. Other impacts:mm_r ... �0 El
14. Impact on Energy
The proposed action may cause an increase in the use of any form of energy. rVNO DYES
(See Part 1. D.2.k)
" trotrs a- e. 1 Noo to Se
hon 15
"Yes answer c arcs ..,. . .
z '
Relevant No,or Moderate
Part I small to large
a .��7�tb,,, z ., % �+ m 'w': ,, r 4, uR�. „ �. , •s' ° p r a'
»�� ��� i„a":f "a + ' "� 1i4� '�S"�`t'� xr � " r u m�•`. �a'� d� a 4 a � M "� � �,
Question(s) Impact Impact may
T,�-occur Glc' B,r
a.The aro)osed action will re uirc a new,or an utgradc to an existing:substation. D2k ❑ ❑'
b.The proposed action will require the creation or extension of an energy transmission Dl If, ❑ ❑
or supply system to serve more than 50 single or two-family residences or to serve a D I q,D2k
commercial or industrial use.
c.The proposed action may utilize more than 2,500 MWhrs per year of electricity. D2k ❑ ❑
d.The proposed action may involve heating and/or cooling of more than 100,000 square Dlg ❑ ❑
feet of building area when completed,
e.Other impacts:
n El
15. Impact on Noise,Odor,and Light
The proposed action may result in an increase in noise, odors,or outdoor lighting. %NO []YES
(See Part 1. D.2.m., n.,and o.)
"Yes Lan rtrr+stior,s a- 1' '7Vo"„ 7o to Section 16.
Relevant No,or Moderate
. Part I
small to large
Question(s) impact impact may
a.The proposed action may produce sound above noise levels established
ma occur occur
Y P � shed by local D2m El -
regulation.
b.The proposed action may result in blasting within 1,500 feet of any residence, D2m,Eld ❑ []
hospital,school,licensed day care center, or nursing home.
c. The proposed action may result in routine odors for more than one hour per day, D2o ❑ ❑
Page 8 ol'10
RESET FORM
d.The proposed action __....�
may result in light shining onto adjoining properties. D2n ❑ ❑
e.apapo o action may result in lighting creatingsky-glow brighter than existing D2,n,EEla 1r
❑ ❑
f.Other impacts:
F16. Impact on
Human Health -•~-
The proposed action may have an impact on human heal-th from exposure NO YES
to new or existing sources of contaminants. (See Part I.D.2.q., E.1. d. f.g., and h.)
1•u,No,:, n 17.
l Yes'", answer�tac.,strons a m ..�
,� � to Sectio
Relevant No,or Moderate
Part 1 small to large
Question(s) impact impact may
care
action is located within 1500 feet hospital,licensed re—c-c 'ur ______Recur
a.The proposed
et of a school ho censed day Eld ❑ ❑
�. .?' jooa, hom ntj sing ome or retnement communi �
b. The site of the proposed action is currently undergoing remediation. Elg, Elh [] ❑
There is a
c completedoradj adjacent
toc he site of the proposed'action.eted environmental site Elg, E'1 h El El
remediation
d.The site of the action is subject to an institutional control
limiting the use of the Elg,Elh El El-�rOPerI (c. ,easement or deed restriclic�n
e.The proposed action may affect institutional control measures that were put in place Elg,Elh ❑ ❑
to ensure that the site remains Protective of the environment and human health.
f.The
eneration t atment and/dor d sposal oous wa
equate rf hazardol measures in ses will be tace to urot ctive ofre that the D2t
g p ofthe
El ❑
environment and human health.
g.The proposed action involves construction or modification of a solid waste D2q,Elf ❑ ]
crroaraag;enaent facilit .
h.The Proposed action may result in the unearthing of g dor hazardous waste. D2 EI
P P y o f ❑ El
L The proposed action may result in an increase in the rate of disposal,or processing,of D2r,132s i] ❑
solid waste.
j.The proposed action may result in excavation or other disturbance within 2000 feet of Elf,Elg []
a site used for the disposal of solid or hazardous waste. EIh El
proposed action may result in the migration of explosive a
P P y 'g � p gases from r�landfill Elf,E11; [] ❑�
k.The ro
site to adjacent off site structures.
1.The proposed action may result in the release of contaminated leachate from the
y D2s,E 1 f, ❑
project D2r
m.Other impacts: El
Page 9 of'10 SET FORM
17. Consistenc°The proposed action is not consistent with adopted land use plans. �NO YES
with Community Plans
(See Part 1. CA, C.2. and C.3.)
If"Yes", answer questions a-h. If"No",go to Section IS.
Relevant No,or Moderate
Part I small to large
Question(s) impact impact may
may occur occur
a.The proposed action's land use components may be different from,or in sharp C2,C3,Dla ❑ ❑
, ` g and use pattern(s), Ela,Elb
contrast to current sur'°oundm l
b.The proposed action will cause the permanent population of the city,town or village C2 _ ❑ []
in which the project is located to grow by more than 5%.
c.The proposed action is inconsistent with local land use plans or zoning regulations. C2,C2,C3 ❑ []
d.TheX -,_
proposed action is inconsistent with an County plans or other regional land use C2,C2 [] [
plans,
e. ebexis.....�.....��.........�...�� ..__._.. �.__.............�_. _ �..
proposed on may cause a change in the density of development that is not C3,Dlc, ❑
supported []
y ting infrastructure or is distant from existing infrastructure, Dld, Dlf,
D1d,Elb
f.The proposed action is located in an area characterized by low density development C4,132c,D2d ❑
that will require new or expanded public infrastructure. D2j
g.The proposed action may induce secondary development impacts(e.g.,residential or C2a _ ❑ ❑
commercial development not included in the proposed action)
__.. ......� �..
h.Other: ❑ 11
18. Consistency with Community Character
The proposed project is inconsistent with the existing community character. WNO YES
(See Part 1.C.2, C.3, D.2, E.3) .
Yes �questions a- � eto Part
t s` Relevant No,or Moderate
answer c u�st
Part I small to large
Question(s) impactimpact may
J-2—ccur
a
a.The proposed action may replace or eliminate existing facilities,structures,or areas De,EM,E3g ❑ El
of historic importance to the community. _
b.The proposed action may create a demand for additional community services(e.g. C4 ❑ D
i
schools,police and fire)
c.The proposed action may displace affordable or low-income housing in an area where C2,C3,D1f ❑ D
there is a shortage of such housing. _ Dlg, Ela
d.The proposed action may interfere with the use or enjoyment of officially recognized C2,E3 ❑ ❑
or designated public resources. _
e.The proposed action is inconsistent with the predominant architectural scale and C2,C3 ❑ ❑
character.
f. existing Proposed action is inconsistent with the character of the ur
p g natural landscape. C2,C3 ❑ ❑
Ela,Elb
E?g,E2h
g.Other impacts ❑ ❑
PRINT FULL FGRMI Page 10 of 10 RESET FULL FGRM
Full En vironmenfal Assessment Form
Part 3 -Evaluation of the Magnitude and Importance of Project Impacts
ond
Deferminatioi,it of Significance
Part 3 provides tile reasons in support of the determination ol'significance. The lead agency inui(cornplete Part 3 for evM question
in Part 2,where the impact has been identified as potentially moderate to large or where there is a need to explain why a particular
cle"Ient of the proposed action will nal,or may,result in a significant adverse environmental impacL
Based oil the analysis in Part 3, the leadagcncy must decide whether to require an environmental impact staloment to further assess
the proposed action or whether available information is sufficient�fbr the lead agency to conclude that the proposed action will not
have a significant adverse environmental impact. By completing the certification on the next page,the lead agency can complete its
determination of significance.
Reasons Supporting This Determination:
To complete this section:
• Identify the inipact based on the Part 2 responses and describe its magnitude. Magnitude considers factors such as severity,
size or extent of,in impact.
• Assess the importance of the impact. Importance relates to the geographic scope,duration,probability of the impact
occurring, number of people affected by the impact and any additional environmental consequences if the impact were to
occur.
• The assessment should take into consideration any design element or project changes.
• Repeat this process for each Part 2 qLICStiOn where the impact has been identified as potentially moderate to large or where
there is a need to explain why a particular element of tile proposed action will not,or may,result in a significant adverse
environmental impact
• Provide the reason(s)why the impact may,or will not,result in a significant adverse environmental impact
• For Conditional Negative Declarations identify the specific condition(s)imposed that will modify the proposed action so that
no signi ficant adverse environmental impacts will result.
• Attach additional sheets, as needed.
Determination of Significance- Type I and Unlisted Actions
�Unlisted
SEQR Status: Type I E,
Identify portions of EAF completed for this Project: L)' Part I D Part 2 Fj Part 3
Upon review of the information recorded on this EAF,as�� ���
noted,plus this additional support information
and considering both the magnitude and importance of each identified potential impact, it is the conclusion of the
El A. This project will result in significant adverse impacts as lead agency that:
P .g on the environment,and,therefore,an environmental impact
statement need not be prepared. Accordingly,this negative declaration is issued.
❑ B. Although this prosect could have a significant adverse impact on the environment,that impact will be avoided or
substantially mitigated because of the;following conditions which will be required by the lead agency:
There will,therefore,be no significant adverse impacts from the prcject as conditioned,and,thereforc,this conditioned negative
declaration is issued. A conditioned negative declaration may be used only for UNLISTED actions(see 6 NYCRR 617.d).
D (", This Project may result in one Or more significant adverse impacts on the environment,and an environmental intpact
statement must be prepared to further assess the impact(s)and possible mitigation and to explore alternatives to,avoid or reduce those
ianpacts. Accordingly,this positive declaration is issued..
Name of Action:
Name of Lead Agency:
Name of Responsible Officer in Lead
P Agency:
Title of Responsible Officer:
Signature of Responsible Officer in Lead Agency:
Date:
Signature of Preparer(if different from Responsible Officer)
Date:
For Further Information:
Contact Person:
Address:
Telephone Number:
E-mail:
For Type 1 Actions and Conditioned Negative Declarations,a copy of this Notice is sent to:
Chief Executive Officer o1•the political subdivision in which the action will be principally located(e.g.,Town/City/
Other involved agencies(if arty) Village of)
Applicant(if any)
Environmental Notice Bulletin: latt LY!"111 dec.nyt,_ov/cnb/enb hmtp
ALL that certain plot, piece or parcel of land,situate, lying and being at Cutchogue,Town of Southold, County of
Suffolk and State of New York, bounded and described as follows:
BEGINNING at the comer formed by the intersection of the southerly side of Main Road with the westerly side of
r Fleets Neck Road;
THENCE along the said westerly side of Fleets Neck Road South 45 degrees 29 minutes 00 seconds East, 200 feet
to a monument;
THENCE South 35 degrees 14 minutes 50 seconds West, 202.67 feet to a monument;
THENCE North 45 degrees 29 minutes 00 seconds West, 175,00 feet to the said southerly side of Main Road;
THENCE along the southerly side of said Main Road following 2 courses and distances:
1)North 29 degrees 44 minutes 00 seconds East, 27,55 feet to a monument;
2) North 28 degrees 12 minutes 30 seconds East, 180.62 feet to a monument at the point or place of
BEGINNING.
r
RQA Properties, LLC
29950 Main Road, Cutchogue, N.Y. 11935
SUM 1000-102-3-1
Request for Change of Zone: Description of Project
APPLICATION IS FOR CHANGE OF ZONE FROM R-40 TO GENERAL BLJSII ES q
Pre-1957:The property was occupied by a public garage (service/gas station -Esso
With an accessory apartment.
1985: RQA Properties, LLC commenced leasing garage to conduct auto sales, repair and body work.
1989: Premises rezoned to R-40 Residential. The existing on site business activities, which included
garage to conduct auto sales, repair,and body work,along with a real estate office, continued as pre-
existing and non-conforming.
2004: On Oct. 25, 2004 RQA Properties, LLC acquired title to property. At that time, insurance Co.
required conversion from a tenant policy to owner's policy which required installation of
environmentally correct spray booth, covering two to three bays at a cost of approximately
$100,000.00.
2005:Application to Zoning Board of Appeals for use variance.The Board found the property does not
qualify for a use variance under section 100-241 and 100-243.The Board determined that, since two
existing principal businesses exist on the property, used car sales are no longer permitted. They found
that, in an R-40 zone, only one use is authorized.
Compliance with Town Code:The present business was in compliance with the Town code until 1989,
when the Town decided to change!the code to R-40. An R-40 zone does not permit the type of
business activities ongoing on the property. The property and its present uses are no longer in
conformance with the Town's zoning laws.
Purpose of Request for Zoning Change: Rezoning this property back to a (general Business District will
bring all the onsite business activities into conformance under the appropriate business district.This
District is the only one that permits, by special exception, a public garage, service station, new and
used vehicle sales under 280-48 B (12).
Benefits to Community: Proposed rezoning will permit owner-to conduct business and plan
improvements to continue a successful business. Future improvements, alterations and additions can
not be planned or pursued under the present R-40;coning label. Neighborhood will benefit from a
successful business that maintains and improves the aesthetics of the property