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Fahey, Sean Patrick
/ Albert J.Krupski,President Town Hall James King,Vice-President Q$VFF��/�'C 53095 Route 25 Artie Foster �o�' P.O.Box 1179 ti y Southold,New York 11971-0959 Ken Poliwoda O Peggy A.Dickerson co = Telephone(631) 765-1892 Qy �� Fax(631) 765-1366 col � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 30, 2002 Ms. Susan E. Long Susan E. Long Permits P.O.Box 46 East Marion,NY 11939-0046 RE: SEAN FAHEY 1415 North Parish Dr., Southold SCTM#71-1-14 Dear Ms. Long: The Board of Town Trustees took the following action during its regular meeting held on Wednesday,April 24, 2002 regarding the above matter: WHEREAS, Susan E. Long on behalf of SEAN FAHEY applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated February 27, 2002, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 24, 2002, at which time all interested persons were given an opportunity to be heard, and, WHEREAS,the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS,the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS,the structure does not comply with the standards set forth in Chapter 97 of the Southold Town Code, 2 WHEREAS,the Board has determined that the project as proposed will affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees DISAPPROVE the application of SEAN FAHEY to install a 3'X 16' ramp, 6'X 20' float with two 2-pile dolphins to secure float on existing 4'X 70' seasonal dock,because the project would monopolize the public bottom and cause damage to the environment. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Fees: None Very truly yours, Albert J. Krupski, Jr. President,Board of Trustees AJK/lms DEC ACE Dept. of State DEPARTMENT OF THE ARMY n NEW YORK DISTRICT,CORPS OF ENGINEERS JACOB K.JAVITS FEDERAL BUILDING - -- - NEW YORK, N.Y.10278-0090 (i+7 Y J7 REPLY TO April 11, 2002 = ATTENTION OF. 'I Eastern Permits Section SUBJECT: Application No. 2002-00351-L2 by Sean Fahey u �•. t1J a The New York District, U.S . Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Sean Fahey ` 25 East 9th Street, Apt 11A New York, New York 10003 ACTIVITY: Install a 3 ' by 1G' seasonal ramp and a 6' by 20 ' seasonal float, secured by two (2) 8" seasonal, 2- pile dolphins, onto an existing 4' by 70' seasonal pier. The purpose of this project is to provide safe mooring for applicant' s vessel (s) . WATERWAY: Peconic Bay, Shelter Island-Sound LOCATION: Town of Southold'; -Suffolk. County, New York As this is minor in nature, authorization .may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States . To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 307 (c) of .the Coastal Zone Management Act of 1972 as amended (16 U.S . C. 1465 (c) (3) (A) ) , -the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of the date of this letter. Sincerely, . Marc Helman - 'Acting Chief Eastern Permits Section Enclosure " G 1 pnopooed 2-pile do PAP�ed 6'x 20'mat i.. - p�Pooedg�, PECONIC BAY x 16.zvalp d.1k Lw 8 WO(Wd�`y ... e�8 Woodjetty � . .. 8P1�tfqat,4ad stnim - ad 8 ` dPt4-1 V Land of Applicant �A4I//r l/� J • A'M+M'ti Prepared by- Susan B.Long Permits P.O. Box 46 East Marion,NY 11939-0046 - (631)477-3455 Prepared for: Sean Fahey 1415 North Parish Drive _ Southold, NY 11971 SCTM#1000-71-1-14 NORTH Proposed: Install 3' x 16' ramp, P�4R/Sy ORM4E 6' x 20' float and two 2-pile dolphins on existing seasonal dock. Scale:. 1" = 30' January 15, 2002 Sheet 1 of 2 yam.. Founders J0, o key Cr PW Landing :? P6Q-0Nc (2 BAY )•:.fowl.. ,. hold lr�� �'. •�� copse,. R p .. K PARISH DRIVe `� Q , 0 4 j GREAT HO a i N,q ^ NECK s o / Adjoining properties: BAY \I E/W Thomas&Joan Lewick Bernard Kiernan 1315 North Parish Drive 25 Wallace Drive Southold,NY 11971 'Plainview,NY 11803 Howard&Bvelyn Lucas Richard Blinkoff 16W North Parish Ihive 1280 North Parish Drive P.O.Box,1735 Southold,NY 11971 Southold,NY 11971 Proposed I~XI?TiNG SEASeHAI / WRAMP- Prop - —� ?,O POCK ZO FLOAT LAWN I Wit sTto C l A w A I+W ,2XtAl. 60TTOM or 5A-Y L E CRo55 VIC-W o• 10, 20. Proposed: Prepared for: Install 3' x 16'ramp,and Sean Fahey 6 x 20'float secured with 1415 North Parish Drive two 2-pile dolphins on existing Southold,NY 11971 70' seasonal dock SCTM#1000-71-1-14 Prepared by. Susan E.Long Permits P.O. Box 46 East Marion,NY 1 1 93 9-0046 January 15, 2002 Sheet 2 of W1)417-3455 f(Qlei ] r �• �, 1 Ot y. j '. IRV Mo • S e MA P OF `V DESCRIBED PROPERT Y. Sl rV ED Ar SAYVIEW TOWN OF SOYMOLD SUFFOLK CO., N. Y. Sea and surveying a W/#"j NOV`qW# engineering RQ 0 west. main street crRrirrtf Tor riverhead, new ygrk 11901 _..._.�-�. (516)369-1717 �10 .. �((�Founders 4 Londrng Jo key Cf' P C.6/�(! C BAY ,o.ST o N CR" QS ;, uT s` - w� A OT uthold �pOSe a 0.,p oAt K �� §n ; N• C �° ^ P`O PARISH DAI VM 's GREAT ` Y NECK peGq r or � a Adjoining properties: ' B A Y Thomas&Joan Lewick Bernard Kiernan 1315 North Parish Drive 25 Wallace Drive Southold,NY 11371 Plainview,NY 11803 Howard&Evelyn Lucas Richard Blinkoff 1600 North Parish Drive 1280 North Parish Drive P.O. Box 1735 Southold,NY 11971 Southold,NY 11071 proposed F-? 13TIN G SEAScNAL IG RAMP- Proposed —� 7,0 POCK ZO FLOAT l3Yl.STtn{G AMHW 13vL.Kke'AD �, 50-T A w HWTOM of6A`f �d . �a .._ SCAL F_ CR055 VIEW o' I o, 20 Proposed: Prepared for: Sean Fahey Install 3'x 16'ramp,and 1415 North Parish Drive 6'x 20'float secured with Southold,NY 11971 two 2-pile dolphins on existing SCTM#1000 19714 70' seasonal dock Prepared by: Susan E.Long Permits P.O.Box 46 East Marion,NY 11939-0046 January 15, 2002 sheet 2 of 2 (631)477-34455 proposed 2-pile dolphins 0 1 `0 PMPOsed 6'x 20,float PmPosed 3•x 16'ra,,B PECONIC BAY - r W°sting"U'1aldo�. LW existing woodletty Odsonspistf,and stairs O°sti°greta'ningwal� stairs Land of Applicant i a'MAYTt Arno Prepared by: I 'r Jrr.OT OM't Susan E.Long Permits P.O.Box 46 East Marion,NY 1193 9-0046 (631 477-3455 c Prepared'for: Sean Fahey 1415 North Parish Drive JL Southold, NY 11971 SCTM#1000-71-1-14 Proposed: Install 3' x 16' ramp, NORTH PARISH 6' x 20' float and two 2-pile dolphins on existing seasonal dock. January 15, 2002 Scale: 1" = 30' Sheet 1 of 2 SEQRA RESOLUTION RE: SEAN PATRICK FAHEY SCTM#71-1-14 Resolved by the Board of Trustees of the Town of Southold that the application of Sean Patrick Fahey, more full described in the public hearing section #14 of the Trustee agenda dated Wednesday, March 20, 2002 is, pursuant to the SEQRA rules and regulations, is declared an Unlisted Action; and be it Further resolved that the applicant is required to submit a Long Environmental Assessment Form (LEAF); and be it Further resolved that upon receipt of the LEAF the Clerk of the Trustees is hereby directed to commence a coordinated review pursuant to SEQRA. oSUF�n�coG c = Town Hall. 53095 Main Road �s P.O. Box 1179 Telephone Southold, New York 11971 (631) 765-1892. Oj , y►��� SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 18, 2002, the following recommendation was made: Moved by Drew.Dillingham, seconded by Bill McDermott, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit Application of SEAN FAHEY to install 3'X 16' ramp, 6'X 20' float with two 2-pile dolphins to secure float on existing 4'X 70' seasonal dock. Located: 1415 North Parish Dr., Southold. SCTM#71-1-14 The CAC recommends Approval with the Condition that the dolphins are seasonal as well. Vote of Council: Ayes: All Motion Carried Albert J.Krupski,President Town Hall James King,Vice-President SVFFOI/QC 53095 Route 25 Artie Foster �� �G P.O.Box 1179 Ken Poliwoda C ?� Southold,New York 11971-0959 Peggy A.Dickerson H 2 Telephone(631) 765-1892 O y Fax(631) 765-1366 �ipl BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 21, 2002 Re: Lead Agency Coordination Request "z Dear Reviewer: The purpose of this request is to determine under Article 8 (State Environmental Quality Review Act-SEQRA) of the Environmental Conservation Law and 6 NYCRR Part 617 the following: . 1. Your jurisdiction in the action described below; 2. Your interest in assuming the responsibilities of lead agency; and 3. Issues of concern that you believe should be evaluated. Enclosed please find a copy of the proposal and a completed Environmental Assessment Form (EAF) to assist you in your response. Project Name: S00t\ M1eC� ScTm#- 71 Requested Action: 11 3rXlid Y'Q � �9` xad -�(ga-y Win c O'Wp s -kb Secau_ -1ocrk- SEQRA Classification: ( ) Type I ( X ) Unlisted Contact Person: (631) 765-1892 Page 2 Lead Agency Coordination Request The lead agency will determine the need for an environmental impact statement (EIS) on this project. Within thirty (30) days of the date of this letter, please respond in writing whether or not you have an interest in being lead agency. If no response is received from you, it will be assumed that there is no objection to the Board of Trustees assuming lead agency status. Comments: Please feel free to contact this office for further information. Very truly yours, Albert Krupski, Jr. President cc: Army Corp. of Engineers Dept. of State DEC (*Maps are enclosed for your review) �1 14-16-2 (9/95)-7c. 617.20 S EQ R Appendix A State Environmental Quality Review FULL ENVIRONMENTAL ASSESSMENT FORM Purpose: The full EAF is designed to help applicants and agencies determine, in an orderly manner, whether a project or action may be significant.The question of whether an action may be significant is not always easy to answer. Frequent- ly, there are aspects of a project that are subjective or unmeasureable. it is also understood that those who determine significance may have little or no formal knowledge of the environment or may not be technically expert in environmental analysis. In addition, many who have knowledge in one particular area may not be aware of the broader concerns affecting the question of significance. The full EAF is intended to provide a method whereby applicants and agencies can be assured that the determination process has been orderly, comprehensive in nature,yet flexible enough 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 information about a givemproject.and its site, By identifying basic:p�oject_: 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 impacts that may occur from a project or action.'It provides ' guidance as to whether an impact is likely to be considered small to moderate or whether it is a potentially large impact: The form also identifies whether an impact can be mitigated or reduced. Part 3: If any impact 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 ❑Part 3 Upon review of the information recorded on this EAF(Parts 1 and.2 and S if appropriate), and any other supporting information, and considering both the magnitude and importance of each impact,it is reasonably determined by;the ' lead agency that: ❑ A. The project will not result In any large and important Impact(s) and,.therefore, is one which will not have a significant impact on the environment, therefore a negative declaration will be prepared. ❑ B. Although the project could have a significant effect on the environment,there will.not be a significant effect for this Unlisted Action because the mitigation measures described in PART 3 have been required, therefore a CONDITIONED negative declaration will be prepared.* ❑ C. The project may result In`one•or`moie'large and important impacts that may have a significant impact on the environment, therefore a positive declaration will be prepared. •A Conditioned Negative Declaration Is only valid for Unlisted Actions oat\ Name of Action Name of Lead Agency Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from responsible officer) �Ia►Ioa� Date " 1 U PART 1—PROJECT INFORMATION Prepared by Project Sponsor NOTICE: This document is designed to assist in determining whether.the action proposed may have a significant effect on the environment. Please complete the entire form, Parts A through E. Answers to these questions will be considered as part of the application for approval and may be subject to further verification and public review. Provide any additional information you believe will be needed to complete Parts 2 and 3. It is expected that completion of the full EAF will be dependent on information currently available and will not involve new studies, research or investigation. If information requiring such additional work is unavailable, so indicate and specify each instance. NAME OF ACTION 5 kA it LOCATION OF ACTION(Include Street Address,Municipality and County) 141 S N • PA 151-E U I✓ NAME OF APPLICANTISPONSOR BUSINESS TELEPHONE ADDRESS t± D SUSAt4 C• 1,01�l , PF-RM I T5 .6 0 C4TY/P0 STAT ZIP CODE E,JhiST NIAF16►4 I I 1q.39-.00Y{ NAME OF OWNER of different' BUSINESS T LEPHONE ADDRESS A PT I I - A CTTyfPO xI STATE..{.. LP:CODE 61F 11500,3 DESCRIPTION OF ACTION I ano -7 Please Complete Each Question—Indicate N.A. if not applicable A. Site Description ` Physical setting of overall project, both developed end undeveloped areas. 1. Present land use: 00rban ❑Industrial OCommercial. ®Residential(suburban) ORural(non-farm) OForest OAgriculture ®Other A1 619-K V RD KI 2. Total acreage of project area: acres. APPROXIMATE ACREAGE PRESENTLY AFTER'COMPLETION Meadow or Brushland (Non-agricultural) "' '" acres — o = acres O acres acres Forested . Agricultural (Includes orchards, cropland, pasture, etc.) -- o acres acres Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) --o acres acres Water Surface Area 0 acres — acres Unvegetated (Rock, earth or fill) CS acres --o acres Roads, buildings and other paved s rface •_T� acres � acres 11�lutrbt. ► b Other (Indicate type) - acres acres. 3. What is predominant soil type(s) on project site? a. Soil drainage: -OWell drained % of site . OModerately well drained % of site OPoorly drained % of site b. If any agricultural land 1s involved, how many acres of soil are classified within soil group 1 through 4 of the NYS Land Classification System? _N#/A—acres. (See 1 NYCRR 370). 4. Are there bedrock outcroppings on project site? OYes . ONO a. What is depth to bedrock? _ (in feet) 2 5. Approximate percentage of proposed project site with slopes: 00-10% % 010-15% % 015% or greater % 6. Is project substantially contiguous;to;',or contain a building, site, or district, listed on the State or the:National Registers of Historic Places? OYe's. ®No 7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? Dyes WNo 8. What is the depth of fhe'Water table? -�'�"—(in feet) 9. Is site located over a primary, principal, or sole source aquifer? OYes ®No 10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? MYes ONo 11. Does project site contain any species of plant or'anifnal life that is identified as threatened or endangered? OYes ®No According to yer N F. L0 N G Identify each species 12. Are there any unique or unusual land forms on the project;`site? (i.e., cliffs, dunes, other geological formations) OYes ®No Describe /A 13. Is the project site presently used by the communit or neighborhood as an open space'or recreation area? OYes ®No .. If yes, explain N A , 14. Does the present site include scenic views known to be important to the community? OYes i3No 15. Streams within or contiguous to project area: NIA a. Name of Stream and name of River to which it is tributary AlJA t• 16. Lakes, ponds, wetland areas within or'r-ontiguous to.project area: a. Name ?1=CD N't C,,'• ' RBI' b. Size (In acres) 17. Is the site served by existing public utilities? ®Yes ONo a) If Yes, does sufficient capacity exist to allow �onnectlon? OYes ONo NIA b) If Yes, will improvements be necessary to allow connection? Oyes ONo N/A 18. Is the site located.in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA, Section 303 and 304? OYes IJNo 19. If.the site located in or substantially contiguous to a Critical Environmental Area designated pursuant WArticle 8 of the ECL, and 6 NYCRR 617? OYes ®No ` 20. Has the site ever been used for the disposal of solid or hazardous wastes? OYes ONo B. Project Description ' 1. Physical dimensions and scale of project(fill in dimensions as appropriate) a. Total contiguous acreage owned or controlled by project•sponsor�—acres. b. Project acreage-to be developed: _acres initially; acres ultimately. c. Project acreage to remain undeveloped - tT Q acres. d. Length of project, in miles: (If appropriate)'. e. -If the project is an expansion, Ind Cate percent of expansion proposed t4 A %; —mot-=`-- f. Number of off-street parking spaces existing ; proposed A g. Maximum vehicular trips generated per hour —(upon completion of project)? h. If residential: Number and type of housiiig•units: , One Family Two Family Mu)tip'1• Family Condominium Initially QQ5-rI N C Ultimately I. Dimensions (in feet) of largest proposed structure 2 height; width; length. j. Linear feet of frontage along a public thoroughfare project will occupy.Is? - aA ft. 3 i 2. How much natural material (i.e., rock, earth, etc.) will be removed from the site? -a— tons/cubic yards 3. Will disturbed areas be reclaimed? OYes ONo ®N/A a. If yes, for what intended purpose is.the site being reclaimed? QI'A b. Will topsoil be stockpiled for reclamation? OYes ONO C. Will upper subsoil be stockpiled for reclamation? OYes ONO 4. How many acres of vegetation (trees, shrubs, ground covers) will be removed4rom site? "d acres. 5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project? OYes ®No 6. If single phase project: Anticipated period of construction bN.E months, (including demolition). 7. If multi-phased: a. Total number of phases anticipated eNE- (number). b. Anticipated date of commencement phase 1 ____4/ month year, (including demolition). c. Approximate completion date of final phase — month: year. d. Is phase 1 functionally dependent.on subsequent phases? Oyes []No 8. Will blasting occur during construction? Oyes ®No 9. Number'of jobs generated: during construction µ ; after project is complete 10. Number of jobs eliminated by this project �- 11. Will project require relocation of any projects or facilities?, OYes ®No If-yes, explain N 12. Is surfaceliquid waste disposal involved? Oyes ONO a. If yes, indicate,type of waste (sewage, industrial, etc.) and amount . b. Name of water body into which effluent will be discharged 13. Is subsurface liquid waste disposal involved? OYes ONO Type N 14. Will surface area of an existing water body Increase or decrease by proposal? OYes ONO Explain BIA 15. Is project or any portion of project located in a 100 year flood plain? OYes ONO 16. Will the project generate solid waste? ' OYes (SNo , a. If yes, what is the amount per month tons b. If yes, will an existing solid waste facility be used? OYes C1No c. If yes, give name � A ; location N I d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? OYes )EINo e. If Yes, explain NJA 17. Will the project involve the disposal of solid Waste? Oyes 0ONo a. If yes, what is the anticipated rate of disposal? IV,I.A— tons/month. b. If yes, what is the anticipated site life? tj JA years. 18. Will project use herbicides or pesticides? OYes MNo 19. Will project routinely produce odors (more than one hour per day)? OYes - ®No 20. Will project produce operating noise exceeding the local ambient noise levels? OYes ®No 21. Will project result in an Increase in energy use? OYes ONO If yes , Indicate type(s) N-r---•- 22, If water supply is from wells, indicate pum ping,capacity A gallons/minute. ' 23. Total anticipated water 'usage per day JA gallons/day. 24. Does project involve Local, State or Federal funding? OYes ONO ' If Yes, explain NIA '4 25. Approvals Required: Submittal Type Date City, Town, Village Board OYes 1gNo City, Town, Village Planning Board OYes %)No City, Town Zoning Board OYes 1KINo City, County Health Department OYes I@No Other Local Agencies %Yes ONo S6 UTKE Lb TOWN T12USr1; 5 0 Other Regional Agencies. OYes 1§No State Agencies NYes ONo N Federal Agencies OYes ONo AWN CGbRR5 C. Zoning and Planning Information 1 . Does proposed action involve a planning or zoning decision? OYes IIONo If Yes, indicate decision required: Ozoning amendment Ozoning variance Ospecial use permit ' ❑subdivision Osite plan Onew/revision of master plan Oresource management plan Oother N JA 2. What is the zoning classification(s)of the site? KGS I LjENT I A L_ U ATF-P,F 96 ar 3. What is the maximum potential development of the site if developed as permitted by the present zoning? N 4. What is the proposed zoning of the site? NIA 5. What is the maximum potential development of the site if developed as permitted by the proposed zoning? N Ik 6. Is the proposed action consistent with the recommended uses in adopted local land use plans? ®Yes ONo 7. What are the predominant land use(s) and zoning classifications within a '/, mile radius of proposed action? RS.S 1D1~NT1hL 1�AT�C�t?in�T' 8. Is the proposed action compatible with adjoining/surrounding land uses within a '/ mile? ®Yes ONo 9. If the proposed action is the subdivision of land, how many lots are proposed? QLJA a. What is the minimum lot size proposed? Al 8 JA 10. Will proposed action require any authorization(s)for the formation of sewer or water districts? Oyes MNo 11. Will the proposed action create a demand for any community provided services (recreation, education, police, fire protection)? Oyes ®No a. If yes, is existing capacity sufficient to handle projected demand? OYes ONo 12. Will the proposed action result in the generation of traffic significantly above present levels? OYes' WNo a. If yes, is the existing road network adequate to handle the additional traffic? OYes ONo D. Informational Details Attach any additional information as may be needed to clarify your project. If there are or may be any adverse impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or avoid them. E. Verification [.certify that the information provided above is rue to the best of my knowledge. Applicant/Spo sor Name I- C- rJEA M ITS Date " 1 ^D&U 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 ,. i Part 2—PROJECT IMPACTS AND THEIR MAGNITUDE Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable? The reviewer is not expected to be an expert environmental analyst. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of 2. The examples are generally applicable throughout the State and magnitude that would trigger a response in column for most situations. But, for.any'.specific projector site other examples and/or.lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each, locality, will vary. Therefore, the examples are illustrative and have been offered as guidance.They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does riot 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 20 questions In PART 2. Answer Yes if there will be any impact. b. Maybe answers should be considered as Yes answers. c, If answering Yes to a question then check the appropriate box(column 1 or 2) to indicate the potential size of the Impact. If Impact threshold equals or exceeds any example provided, check column 2. If Impact will. occur but threshold Is lower than example;;check column 1,, d. Iden(Ifying.that an Impact will be potentially large (coidmn'2j does-not mean that It is also necessarily significant. Any large Impact must be evaluated In PART 3 to determine significance.Identifying an Impact to column 2 simply asks that It be looked at further. e. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. I. If a potentially large impact checked In column 2 can be mitigatedby.change(s)In the project to a small to moderate Impact, also check the Yes box In column 3. A-No response Indicates that such a reduction is not possible. This must be explained in Part 3. 1 2 3 Small to Potential Can Impact Be Moderate Large. Mitigated By IMPACT ON LAND Impact Impact Project Change 1 . Will the proposed-action result Ina physical change to the project site? ONO DYES Examples that would apply to column 2 ❑ QYes ❑No • Any construction on slopes of 15% or greater, (15 fd'ot Vise per 100 ❑ foot of length), or where the general slopes in the project area exceed 10%. • Construction on land where the depth to the water table is less than ❑ ❑ ❑Yes ❑No 3 feet. ❑ ❑ ❑Yes ❑No • Construction of paved parking area for 1,000 or more vehicles. ❑ ❑Yes ❑No • Construction on land where bedrock is exposed or generally'within ❑ 3 feet of existing ground surface. ❑ Oyes ❑No • Construction that will continue for more than 1 year or involve more ❑ than one phase or stage. ❑ that would remove more than 1,0.00 ❑ ❑Yes ❑No Excavation for mining purposes tons of natural material (i.e., rock or soil) per year. ❑No ❑ ❑Yes • Construction or expansion of a sanitary landfill. ❑Yes ❑No • Construction in a designated floodway. ❑ Q ❑ ❑Yes ❑No • Other impacts 2. Will there be an effect to any unique or unu;ual land forms found on the site?(i.e., cliffs,dunes, geological formations, etc.)ONO OYES ❑Yes ❑No • Specific land forms:. ❑ ❑ 6 Part 2—PROJECT:IMPACTS AND.THEiR MAGNITUDE . Responsibility of Lead Agency General Information (Read Carefully) • In completing the form the reviewer should be guided by the question: Have my responses and determinations been reasonable) The reviewer is not expected to be an expert environmental analyst. • The Examples provided are to assist the reviewer by showing types of impacts and wherever possible the threshold of magnitude that would trigger a response in column 2. The examples are generally applicable throughout the State and for most situations. But, for any"specific.'project or site other examples and/or lower thresholds may be appropriate for a Potential Large Impact response, thus requiring evaluation in Part 3. • The impacts of each project, on each site, in each locality, will vary. Therefore, the examples are-illustrative and have been offered as guidance.They do not constitute an exhaustive list of impacts and thresholds to answer each question. • The number of examples per question does not indicate the importance of each question. • In identifying impacts, consider long term, short term and cumlative effects.- Instructions (Read carefully) a.. Answer each of the 20 questions In PART 2. Answer Yes i� there will be any impact. b. Maybe answers should be considered as Yes answers. c, If answering Yes to a question then check the appropriato box(column 1 or 2) to indicate the potential-size of the impact. If Impact threshold equals or exceed, any exampty provided; check column 2. If Impact will occur but threshold Is lower than example;;check column 1.. d. Identifying that an Impact will be potentially large (co(urtin 2)does not mean that It is also necessarily significant. Any large Impact must be evaluated In PART 3 to determine significance.Identifying an Impact to column 2 simply asks that It be looked at further. e. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3. f. If a potentially large impact checked in column 2 can be mitigatedtby.change(s)In the project to a small to moderate Impact, also check the Yes box In column 3. A-No response Indicates that such a reduction is not possible.This must be explained in Part 3. 1 .2 3�� Small to Potential'. .Can Impact Be Moderate_ Large.. Mitigated By IMPACT ON LAND Impact ''Impact 'Project Change 1. Will the proposed-action result in a physical change to the jNOcjec't7YE5 '. F_xamples that would apply to column 2 ❑ ❑yeS ❑No • Any construction oil slopes of 15% or greater, (15 fdct rise per 100 ❑ foot of length), or where the general slopes In the project area exceed 10%. ❑ ❑Yes ❑N�� • Construction on land where the depth to the water table is less than ❑ 3 feet. ❑ ❑ ❑Yes ❑No • Construction of paved parking area for 1,000 or more vehicles. . • Construction on land where bedrock is exposed or generally'within ❑ ❑ QYes ❑No 3 feet of existing ground surface. ❑ ❑Yes ❑No • Construction that will continue for more than.1 year or involve more ❑ than one phase or stage. • Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No tons of natural material (i.e., rock or soil) per year. ❑ ❑ ❑Yes ❑No • Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ❑No • Construction in a designated floodway. ❑ ❑ ❑Yes ❑No • Other impacts 2. Will there be an effect to any unique or unusual land forms found on the site?(i.e., cliffs,dunes, geological formations, etc.)ONO OYES ❑ ❑ ❑Yes ❑No • Specific land forms:. 6 1 2 3 Small to Potential Can Impact Be IMPACT ON WATER Moderate Large Mitigated By 3. Will proposed'action affect any water body designated as protected? Impact Impact Project Change (Under Articles.15, 24, 25 of the Environmental Conservation Law, ECL) ONO OYES Examples that would apply to column.2 • Developable area of site contains a protected water body. ❑ ❑ ❑Yes ❑No • Dredging more than 100 cubic yards of material from channel of a ❑ ❑ ❑Yes ❑No protected stream. • Extension of utility distribution facilities through a protected water body. ❑ ❑ ❑Yes ❑No • Construction in a designated freshwater or tidal wetland. ❑ ❑ Dyes ❑No • Other impacts: O. ❑ ❑Yes ONo 4. Will proposed action affect any non-protected existing or new body of water? ONO . ' OYES Examples that would apply to column 2' • A 10% increase or decrease in the surface area of any body of water ❑ ❑ [)Yes ❑No or more than a 10 acre increase or decrease. • Construction of a body of water that exceeds 10 acres of surface area. ❑ ❑ Dyes ❑No • Other impacts: ❑ ❑ ❑Yes ❑No 5. Will Proposed Action affect surface or groundwater quality or quantity? ONO OYES Examples that would apply to column 2 • Proposed Action will require a discharge permit. ❑ ❑ Dyes ❑No • Proposed Action requires use of a source of water that does not ❑ ❑ Dyes ❑No have approval to serve proposed (project) action. • Proposed Action requires water supply from wells with greater than 45 ❑ ❑ Dyes ❑No gallons per minute pumping capacity. • Construction or operation causing any contamination of a water ❑ ❑ Dyes ❑No supply system. • Proposed Action will adversely affect groundwater. ❑ ❑ ❑Yes ❑No • Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ Dyes '❑No do not exist or have inadequate capacity. • Proposed Action would use water In excess of 20,000 gallons per ❑ ❑ ❑Yes ❑No day. • Proposed Action will likely cause siltation or other discharge into an ❑ ❑ ❑Yes ❑No 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 ❑ ❑ ❑Yes ❑No products greater than 1,100 gallons. • Proposed Action will allow residential uses in areas without water ❑ ❑ Dyes ❑No and/or sewer services. • Proposed Action locates commercial and/or industrial uses which may ❑ ❑ Dyes ❑No require new or expansion of existing waste treatment and/or storage facilities. • Other impacts: y ❑ ❑ Dyes ❑No 6. Will proposed action alter drainage flow or patterns, or surface water runoff? ONO OYES j Example that would apply to column 2 • Proposed Action would change flood water flows. 7 ❑ ❑ Dyes ❑No 1 2 3 Small to Potential Can Impact Be Moderate Large Mitigated By Impact. Impact Project Change Proposed Action may cause substantial erosion. ❑ ❑ ❑Yes ONo Proposed Action is incompatible with existing drainage patterns. ❑ ❑ ❑Yes ONo Proposed Action will allow development in a designated floodway. ❑ ❑ ❑Yes ONo Other impacts: ❑ ❑ ❑Yes ONo IMPACT ON AIR Will proposed action affect air quality? ONO OYES Examples that would apply to column 2 Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ ❑Yes ❑No hour. Proposed-Action will result in the incineration of more than 1 ton of ❑ ❑ ❑Yes ❑No refuse per hour. Emission rate of total contaminants will exceed 5 lbs. per hour or a ❑ ❑ ❑Yes ONo heat source producing more than-10 million BTU's per hour. Proposed action will allow an increase in the amount of land committed ❑ ❑ ❑Yes ONo to industrial use. Proposed action will allow an increase in the density of industrial •❑ ❑ ❑Yes ONo development within existing industrial areas. Other impacts: ❑ ❑. ❑Yes ONo IMPACT ON PLANTS AND ANIMALS ,. Will Proposed Action affect any threatened or endangered species? ONO OYES Examples that would apply to column 2 Reduction of one or more species listed on the New York or Federal ❑ ❑ ❑Yes ONo list, using the site, over or near site or found on the site. Removal of any portion of a critical or significant wildlife habitat. ❑ ❑ ❑Yes ONo Applicafion of pesticide or herbicide more than twice a year, other ❑ ❑ ❑Yes ❑No than for agricultural purposes. O(her impacts: ❑ ❑ ❑Yes ONo i. Will Proposed Action substantially affect non-threatened or non-endangered species? ONO OYES Examples that would apply to column 2 Proposed Action would substantially interfere with any resident or ❑ ❑ ❑Yes ONo migratory fish, shellfish or wildlife species. Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes ONo of mature forest (over 100 years of age) or other locally important vegetation. IMPACT ON AGRICULTURAL LAND RESOURCES ' 0. Will the Proposed Action affect agricultural land resources? ONO OYES Examples that would apply to column 2 The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes ONo land (includes cropland, hayfields, pasture,' vineyard, orchard, etc.) 8 1 2 3 Small to Potential Can Impact E Moderate Large Mitigated B) Impact Impact Project Chan( • Construction activity would excavate or compact the soil profile of ❑ ❑ ❑Yes ❑N. agricultural land. • The proposed action would irreversibly convert more than 10 acres ❑ ❑ [--]Yes of agricultural land or, if located in an Agricultutal District, more than 2.5 acres of agricultural land. • The proposed action would disrupt or prevent installation of agricultural ❑ ❑ [Dyes ❑N, land management systems (e.g., subsurface drain lines, outlet ditches, strip cropping); or create a need for such measures (e.g. cause a farm field to drain poorly due to increased runoff) ❑ ❑ ❑Yes ❑N. • Other impacts: IMPACT ON AESTHETIC RESOURCES 11. Will proposed action affect aesthetic resources? ONO OYES (If necessary, use the Visual EAF Addendum in Section 617.20, Appendix B.) Examples that would apply to column 2 ❑ ❑Yes ❑N( • Proposed land uses, or project components obviously different from ❑ or in sharp contrast to current surrounding land use patterns, whether. man-made or natural. ❑ (:Dyes ❑Nc • Proposed land uses, or project components visible to users of ❑ aesthetic resources which will eliminate or significantly reduce their enjoyment of the aesthetic qualities of that resource. ❑ ❑Yes ❑N( • Project components that will result in the elimination or significant ❑ screening of scenic views known to be important to the area. ❑ ❑ ❑Yes ❑N( • Other impacts: IMPACT ON HISTORIC AND ARCHAEOLOGICAL, RESOURCES 12. Will Proposed Action impact any site or structure of hisstoricaYES historic or paleontological importance? ONO Examples that would apply to column 2 ❑ Oyes ON( • Proposed Action occurring wholly or partially within or substantially ❑ contiguous to any facility or site listed on the State or National Register of historic places. ❑ ❑Yes ❑Nc • Any impact to an archaeological site or fossil bed located within the ❑ project site. ❑ ❑Yes ON( • Proposed Action will occur In an area designated as sensitive for ❑ archaeological sites on the NYS Site Inventory. ❑ O ❑Yes ON( • Other impacts: IMPACT ON OPEN SPACE AND RECREATION 13. Will Proposed Action affect the quantity or quality of existing or future open spaces or recreational opportunities? Examples that would apply to column 2 ONO OYES ❑ OYes ON, • The permanent foreclosure of a future recreational opportunity. o O OYes ❑N` • A major reduction of an open space Important to the community. ❑ ❑ ❑Yes ❑N` • Other Impacts: 9 1 2 3 Small to . Potential Can Impact Be Moderate Large Mitigated By Impact Impact Project Change IMPACT ON CRITICAL ENVIRONMENTAL AREAS 4 . Will Proposed Action impact the, exceptional or unique character- istics of a critical environmental area (CEA) established pursuant to subdivision 6 NYCRR 617.14(g) ? ONO OYES List the environmental characteristics that caused the designation of the CEA. Examples that would apply to column 2 Proposed Action to locate within the CEA? ❑ ❑ ❑Yes ❑No Proposed Action will result in a reduction in the quantity of the resource? ❑ ❑ ❑Yes ❑No Proposed Action will result in a reduction in the quality of the resource? ❑ El ❑Yes ❑No Proposed Action will impact the use, function or enjoyment of the ❑ ❑ ❑Yes El No resource? Other impacts: ❑ El Dyes ONo IMPACT ON TRANSPORTATION 15. Will there be an effect to existing transportation systems? ONO OYES Examples that would apply to column 2 Alteration of present patterns of movement of people and/or goods. ❑ ❑ ❑Yes ❑No Proposed Action will result in major traffic problems. Cl ❑ ❑Yes ❑No Other impacts: El ❑ ❑Yes ❑No IMPACT ON ENERGY 16 Will proposed action affect the community's sources of fuel or energy supply? . ONO DYES Examples that would apply to column 2 Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ ❑Yes ❑No any form of energy in the municipality. • Proposed Action will require the creation or extension of an energy ❑ ❑ ❑Yes ❑No transmission or supply system to serve more than 50 single or two family residences or to serve a major commercial or industrial use. • O El ❑ ❑Yes ❑No Other impacts: 10 1 2 3 NOISE AND ODOR IMPACTS Small to Potential Can Impact Be Moderate Large Mitigated By 17. Will there be objectionable odors, noise, or vibration as a result Impact Impact Project Change of the Proposed Action? ONO OYES Examples that would apply to column 2 ❑ ❑Yes ❑No • Blasting within 1,500 feet of a hospital, school or other sensitive ❑ facility. ❑ ❑ Dyes ❑No • Odors will occur routinely (more than one hour per day). ❑ ❑Yes ❑No • Proposed Action will produce operating noise exceeding the local ❑ ambient noise levels for noise outside of structures. ❑ ❑ ❑Yes ❑No • Proposed Action will remove natural barriers that would act as a noise screen. ❑ ❑ ❑Yes ❑No • Other impacts: IMPACT ON PUBLIC HEALTH 18. Will Proposed Action affect public health and safety? . ONO OYES Examples that would apply to column 2 ❑ ❑Yes ❑No • 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 low level discharge or emission. ❑ ❑ El Yes ❑No • Proposed Action may result in the burial of"hazardous was in any form (i.e. toxic, poisonous, ' highly reactive, radioactive, irritating, infectious, etc.) ❑ ❑Yes -]No Storage facilities for one million or more gallons of liquified natural ❑ gas or other flammable liquids. El ❑Yes ONO • Proposed action may result in the excavation or other disturbance ❑ within 2,000 feet of a site used for the disposal of solid or hazardous waste. ❑ ❑ ❑Yes ❑No • Other impacts: IMPACT ON GROWTH AND CHARA¢TER OF COMMUNITY OR NEIGHBORHOOD 19. Will proposed action affect the character of the existing ONO mmDYES Examples that would apply to column 2 • The permanent population of the city, town or village in which the ❑ ❑ ❑Yes ❑No project is located is likely to grow by more than 5%. ❑ ❑Yes ❑No • The municipal budget for capital expenditures or operating services ❑ will increase by more than 5% per year as a result of this project. ❑ ❑Yes ❑No • Proposed action will conflict with officially adopted plans or goals. O ❑ ❑Yes ❑No • Proposed action will cause a change in the density of land use. ❑ ❑Yes ❑No • Proposed Action will replace or eliminate existing facilities, structures _❑ or areas of historic importance to the community. ❑ ❑Yes ❑No • Development will create a demand for additional community services ❑ (e.g. schools, police and fire, etc.) ❑ ❑Yes ❑No • Proposed Action will set an important precedent for future'projects. 0 ❑ ❑Yes ❑No • Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes ❑No • Other impacts: 20. Is there, or is there likely to be, public controversy related to potential adverse environmental Impacts? ONO DYES If any action In Part 2 Is Identlfled as a potential jarge Impact or If you cannot determine the magnitude of Impact,proceed to Part 3 11 � Part 3—EVALUATION OF THE IMPORTANCE OF IMPACTS Responsibility of Lead Agency ,art 3 must be prepared if one or more impact(s) is considered to be potentially Large, even if the impact(s) may be nitigated. nstructions discuss the following for each impact identified in Columri 2 of Part 2: Briefly describe the impact. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s). s Based on the information available, decide if it is reasonable to conclude that this impact is important. To answer the question of importance, consider: • The probability of the impact occurring • The duration of the impact • Its irreversibility, including permanently lost resources of value • Whether the impact can or will be controlled • The regional consequence of the impact • Its potential divergence from local needs and goals • Whether known objections .to'the project relate to this impact. (Continue on attachments) 12 " 14.14.11 (9/95�-9c 617.20 SEQR Appendix B State Environmental Quality Review Visual EAF Addendum This form .may be used to provide additional information relating to Question 11 of Part 2 of the Full EAF. (To be completed by Lead Agency) Distance Between Visibility Project and Resource (in Miles) 1. Would the project be visible from: 0.1/4 1/4.1/z 1/2.3 3.5 5+ • 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 El El ❑ ❑ observation, enjoyment and appreciation of natural or man-made scenic qualities? • A site or structure listed on the National or State ❑ ❑ ❑ ❑ ❑ Registers of Historic Places? • State Parks? ❑ ❑ ❑ ❑ ❑ • The State Forest Preserve? ❑ ❑ ❑ ❑ ❑ • National Wildlife Refuges and state game refuges? ❑ Cl ❑ ❑ ❑ • National Natural Landmarks and other outstanding ❑ ❑ ❑ ❑ .❑ naturalfeatures? • 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? ❑ ❑ ❑ ❑ ❑ 2. Is the visibility of the project seasonal?(i.e., screened by summer foliage, but visible during other seasons) OYes ❑No 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 1 DESCRIPTION OF EXiSTING VISUAL ENVIRONMENT 4. From each item checked in question 1, check those which generally describe the surrounding environment. Within *'/4 mile *1 mile Essentially undeveloped ❑ ❑ Forested Agricultural Suburban residential ❑ ❑ Industrial ❑ ❑ Commercial ❑ ❑ Urban ❑ ❑ River, Lake, Pond ❑ Cliffs, Overlooks ❑ ❑ Designated Open Space ❑ ❑ Flat ❑ ❑ Hilly ❑ ❑ Mountainous ❑ ❑ Other NOTE: add attachments as needed 5• Are there visually similar projects within: •1/z mile ❑Yes El No •1 miles ❑Yes ❑No •2 miles ❑Yes ❑No •3 miles ❑Yes El 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: When 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 ❑ a ❑ ❑ 2 i Albert J. Krupski, President QSUFF���.�'C, Town Hall James King,Alice-President ���� OGy 53095 Route 25 Henry Smith P.O. Box 1179 .Artie Foster � z, Southold, New York 119 7 1-0959 Ken Poliwoda CP • Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES ORIGINAL TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Applicatio _Wetland Permit Application Major Minor _Waiver/Amendment/Cha ges _Received Applicati n: a2 0 _Received Fee:$ _ _Completed Application Q-k- __Incomplete _ SEQRA Classification -oc d� `moo V Type I Type II Unlisted_�� Coordination'.(date sent _CAC Referral Sent: o_ _Date of Inspection: o ___Receipt of CAC Report:_ —_Lead Agency Determination: _Technical Review: Public Hearing Held: Resolution: Name of A- )plicnnt SJ�aNt Ff{f-f(±�l Address EA51' 5T. AF—T. J(A [0663 Phone Number. yf Suffolk County Tax Map Number. 1000 - '71 Property Location: l ► _ PARISH DW- , pU T1fC2L (provide LILCO Pole #, distance to cross streets, and location) I AGENT: -LK1S ESL C RARI Nl: CDNSCIZt)C.TfO� l/ (Ifapplicable) CIO SSAN E, . l,Otq 6 Fr RM ITS Address: EPrSr_ _-AR Icy - - _ Phone:_ , I � i' Board of Trustees Application GENERAL DATA Land Area (in square feet): ��y t a Do -r -- Area Zoning: Previous use of property: EU s11 Nib U 1,K4 rAkbr h R 1;- A 5i4CF— Intended use of property: N U GFf A N6 C.::- Prior permits/approvals for site improvements: Agency Date KR E K Now No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? a -- No Yes If yes, provide explanation: NTH! Project Description (use attachments if necessary): F11b44`I' 0 XL Ex 5Tr1N 6 x 76 �� 56ISLffL_ 12OC, k Lard of Trustees App1 icati:on WETLAND/ RUSTEE LANDS APPLICATION DATA A _t l Purpose of the proposed operations: S C.,� tJ R 13 C5 i ry NT/A 4, IL1bTO (t. B1) A-T AR b -,SA7Er-- Ac.r ESQ i Area of wetlands on lot: square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: ,+ feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? —b — cubic yards How much material will be filled? - Ci cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: N A Manner in which material will be removed or deposited: N/4 Statement of the erect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations,(use attachments if appropriate): UJ1 L REMDU J� S5,450NA q Bo of Trustees Application County of Suffolk State of New York SusPrN BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID. PERMIT(S) , IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES( S) , TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS vl `LI DAY OF Notary Public CLAIRE L.GLEW Notary Public,State of New York No.01 GL4879605 Qualified in Suffolk Countv�D Commission Expires Dec.8,��^��sS1� 7 1 AUTHORTZA'TION FORM Date: I l C c 6 f 1, SrR�j Ri4i (J y owner of M 5 N Pfi w� (name) 7(street address) located at _S'o v i!A oL1 �`y do hereby give Ian C,R��� L , (town & state) and Susan E. Long the authority to act as agent on my behalf in a col tractor) pp yang for all necessary permits for work to be done on my property described above. �—z' e Sign ture . i Mar 20 02 12: 49p Susan E. Long 516-477-3455 p. 4 Albert J. Krupski, President pSVfFO�/�'C Town Hall James King,Vice-President 53095 Route 25 Henry Smith P.O.Box 1179 Artie Foster y Z Southold,New York 11971-0959 Ken Poliwoda Telephone (631)765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of --------- ------ ---------------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING t )(Ai LE residing residing at _ K FF f•( PO R r �- being duly sworn, de ose and say: That on the 12"r day of MfKCA, 200--L, I personally posted the property known a s L y/S N_ pA K IS D - ,Sn urn A L D by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date o the ublic hearing. Date of hearing noted thereon to be held IV Dated: (signature Sworn to before me this ZO day of j,-jhRX if 200i2_ 2:' SUSAN E. LONG _AA A,4,0 dd ) - —:;e . Notary Public, State of New York Notary Public No. —�;D. .�5r;>23 Q 31ified ;n S;.,;rolk County Commission Expires(November 6,a&Q_5_ PROOF OF MAILING OF NOTICE Postal Service IFIED MAIL RECEIPTS a CERTIFIED RECEIPT $ Postal Service i Ad omesti.Mail Only, No i • . . IED MAIL ■ ■ s .. Mail'only) No insurance Coverage Provided) to a Co -0 Article Sent To: SOUTHOLD, NY 11971 Postage $ 0.3 4 UNIT ID: 0939 S011THOLDa W 11971 `O Certified Fee Postage $ 0.34 UNIT ID: 0939 (�- S 2.10 Postmark S � I r- � Return Receipt Fee Here Certified Fee �'10 rU (Endorsement Required) Postmark Return Receipt Fee Here Restricted Delivery Fee Clerk: KZCQHO ru (Endorsement Required) C3 (Endorsement Required) E] I M e3 Restricted Delivery Fee Clerk: IiZGQHO I q p Total Postage&Fees $ 2.44 03/06/02 { O (Endorsseementt Required) °a -0 `a o Total Postage&Fees $ 2.44 03/06/02 r� O Name(Please Print Clearly)(to be completed by mailer) j .1 `� M Name(Please Print learly)(to be completed by mailer) ------ o- V r" I,.V CA rl � Street,Apt.No.;or PO Box No. e S ca Ttf 0MR5_t-Z0AN-----L9W1C—K-------------------------- Street,r- '�� State,ZIP+4 Pik �4H DQ2,--- tea k �7 ; Q IA o. PO Boxt.f... P/��z tS D RSV O �- i N City State,ZlP+4 p ----------------- o oG � N14 (g71 O Name(Please Print Clearly) to be completed by mailer) -^ + 4 �_t,J t.No,�-- 4 ` [� Total Posta e&Fees $ 2■44 ©3/Or]10c I 0 "Street,Apt.►N/.o�Qor POI Box No. ]� '/[ � g � �✓ 1["f 4L 1.ACX-----'!i��v I ( Y)( p Y ) I C7 --it -S ate, ---- I - --------------------- ` Name Please Print Clearly) to be mailer (. City,State,ZIP+4 Q �L ,,VV l - o R_l_CH:A - ------ - � Street,Apt.No.;or PO Box No. y •• - o _gas-d t �_�t PRE t-li-V r- City,State,ZIP+4 COUNTY OF SUFFOLK 560—' OL N11971 PS Form 3800,July'1999 See Reverse for Instructions 'PAOL 754K F— residing at Nru) YOTR k_ being duly sworn, deposes and says i that on th �_ day of W) gx-k , deponent mailed a true copy of the Notice set forth in the Board of ' Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of 'Southold; that said Notices were mailed at the United States Post Office at , that said Notices were mailed to each of said persons by (certified) (registered) mail . Sworn to before me this Notary S E.LOte �e�vYoric day of _VYl A �C ®� NO.01 LO44958343 Qualified in Suffolk County Commission Expires November.6,40qa otary Pub is a ' , Pi-4 q. •a • a u'b •74 - N Ja poo W N 304.000 d7•�.��44P- t i — SOO HOLD BAY HHOLD TOWN OF SOUT '0$ _ _ _ y° p,A3 2 - ` .1 n _ _ 2� ao. ay L HL L 43 aao-r� 4�' 1.4A(c) 4 5 6 7 8 9 10 a 1112 t 9 16,1 3 OA[G �, _ .-, I'----1 •3 N4 15 16.2M1 2.4A(C) � � ,! � � 4 y a• N. PARISH a w an an nsDR. �:'::.'.•;:<:.':.�. -::,,`c'";"� � ., FsoOErREe`-�PSo,FEAC-cLo.JNs6�. •�'�O'8, S 8 rp � mru as =Qrl a-o a �,K _ .v _ am e >u - "ur 50) �ma 8 B a 111 8 & 4 333 32 30k29 28 27 26 $ m 20 41cl ro- kIkBOR USkjS ,ro +ro aro F 16~� m ,g 24 = 2ti a� L2A(c)/ ry� ^aoo x,� a- aro DR, am ti _ k Pyp�G n 39 38 37 N "a 3I 22 '�' i0•>d' ;� Ao a 1L3 mO10 T $ aro (SO ,ro 17 Z N e 3 �e ,} '+ + +x +ss a� 36'+� DRT/¢IELD am U. .t.9 ' s 8 r-3' r+a C& 12 13 ao f g pry 19� 15x I^` ..j I__' N J04.z00 d 0 ( a•� aoa rW .1S uu 5,1 -)b -: _ � IAATL:1 LSL• � I � � � 1L2�� a,y � 1 R6 •ram r W SEE INSERT l -,•.-__. �^•a •' .- ._ •.5 'A'DRAIN OTHERWISE. ALL PROPERTIS ICE y COUNTY OF SUFFOLK Q K r ���� _ I L I r,.anV a Ib &bawl.wt It as .Litt x—- imti� NOT saoaom.tt�� ——sa+— xysant li.rrtel L;rc — E ARE WITHIN THE FOLLDWMG DISTRICTS. �� ''� Real Property Tax Service Agency .f ✓ .,rn i r � 121) /1 -— —_F—_ q y —_R—_ 5 � 5 SEWER nD UAMR:NANCE.ALTERATION,SALE OR E Iwo..r.�n o� —T'— man (`c/1FIRE Ci I ------ IMed n.W.Au, :4a 1101af�`�u1° —- —- � ISu —NST—— LCXT 43 WAS i suFFOLIC COUMY TAX MAP PROFITED ® County Ceder Riverhead,N Y 11901 M L,n lte SCALE IN FEET: o-a _C—_ A=d1 uilrtt Lt.—_A—_ PART: REFLISE WITHOUT WRITTEN PERWISSION OT THE g®� o SO M P I r. E sm•a u�m« o. j ra"ry trn -- j wn v tr w — S - Stro,o;store WASTEL:TER .a2i•_� Oe.d,b.0 12.1 A(d) or 12.1A Tcm lie --- Fort I>4vit Ito --P—- Io.t..w mm l t Lte—tW--- AY-dA.AtA•'E REAL PROPERTY TAX SERVICE AGENCY- Ni - p I Pura No. mmotw a.a V-1 A(C) raaw uu s.-ftft"uo —--—- - s '•fr>mot;,",' kt A"r-t f !i,' - ,,. -.G4-..• _ ..�.s<L. '••r.`4.' 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