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Board Of Southold Town Trustees ► '
SOUTHOLD, NEW YORK
a DATE:
PERMIT NO. �S . ....... . .... ...........
DA 9 28 95 �
E..................................... ............
ISSUED TO < '
_ .......STANL.EY...C.H2},5... � -
11 Pursuant to the provisions of Chapter 615 of the Laws of 'r A
'may ' the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled "REGULATING
!: ti
AND THE PLACING OF OBSTRUCTIONS
'j IN AND ON TOWN WATERS AND PUBLIC LANDS and the �w
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM jS ,
LANDS UNDER TOWN WATERS;" and in accordance with the
Resolution of The Board adopted at a meeting held on .9./.2.8195........
i'
19.9.5....... and in consideration of the sum of $...150-0.0 ....... paid by E
En-.C.o.ns.ultant�s...Zn�........fo.r..STANLEY...CHASE
•
..................... `+ ti
of .......Mattituck. ........... ..... .•.. ,..•... .... ... N. Y. and subject to the °
Terms and Conditions listed on the reverse side hereof, ?'
E a of Southold Town Trustees authorizes and permits the following: a «
" r To construct a timber dock a min. of 4 above grade of marsh
al a 3' X 30' fixed catwalk, extending from top of bank as shown on!�,
survey, a 3' X 10' hinged ramp and a 6' X 16' float in "T" config�
ands cured b (2) 8'' p'1in s
1 a�C in accorYdance with the detailed specifications as presented in ;
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
} by causes its Corporate Seal to be affixed, and these presents to j
be subscribed by a majority of the said Board as of this date.
........ ........ �. k
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Trustees .:
141
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1ohmHolz3pfe1, Vice President f 53095 Main Road
• William G. ,Albertson " y ' ' :, z 4 . P.O. Box 1179
s.
IYartin H. Garrell v r ' A _. Southold, New York 11971
Peter Wenczel 5%
1 Telephone (516) 765-1892
. -• Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Onl
Weastal Erosion Permit Application �-
tland Permit Application.
Grandfather Permit Application AUG 3 1 1995
Trustee Lands Permit Application
Waiver
,`Received Application: TOWN OF SOUTH
✓ lerical Review:
Completed Application ^losr�
Incomplete
SEQRA Classification-
Type e I Type II Z; unlisted
ordination: (date sent)
kReferral Sent: 9<(�
e of Inspection:eipt of CAC Report: (date)d Agency Determination:
hnical Review: (date)lic Hearing: (date) g
Decision: Approved (Y/ ) (date)
Application Fee:Slmod
Name of Applicant Stanley Chase
Address 116 Centre Island Road
Oyster Bay, NY 11771 Phone Number: (516 ) 922-1808
Suffolk County Tax Map Number: 1000 - 115-12-12
Property Location: Deep Hole Drive,Mattietuck, NY 11952
( provide LILCO Pole -,' , distance to cross streets, and locat'cn; _
Agent: , En-Consultants , Inc.
( If applicable)
Address : 1329 North Sea Road
Southampton, NY 11968 Phone : ( 516 ) 283-6360
i
Ze'd ld101
PROJECT DESCRIPTION
Construct a timber dock a minimum of h' above grade of
marsh and 3 ' x 30' fixed catwalk extending from. top of
"bank" as shown on survey; 3 ' x 12' hinged ramp; 6' x 16'-
float arranged in "T" configuration and secured by (2)
8110 pilings.
Letter of "No jurisdiction" is requested for the
construction of a one family dwelling, deck, sanitary
system, driveway, which are all shown on the attached
site plan of Van Tuyl. All work will be in excess of 75'
from nearest wetland/water.
Z0'd £Z8TS9L Ol ONI `S1Ndl-if1SNOJ-N3 WDN=l WdOS:10 S66T-0£-80
GENERAL DATA
Land Area ( in square feet) : 10,300
Area Zoning: R-40
Previous use of property: Vacant residential
Intended use of property: Residential
Prior permits/approvals for site improvements:
Agency Date
X No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
x No Yes
If yes , provide explanation:
Proiect Description ( use attacll=ents if necessary) :
SEE ATTACHED
Hoard of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Private boat dockage
Area of wetlands on lot: 1495 square feet
Percent coverage of lot: 15 %
Closest distance between nearest existing structure and upland
edge of wetlands:-- N/A feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 130 feet
Does the project involve excavation or filling?
X No Yes
If yes , how much material will be excavated? N/A ct:bic yards
How much material will be filled? N/A cubic yards
Depth of which material will be removed or deposited: N/A
feet
Proposed slope throughout the area of operations: 0% - 10%
Manner in which material will be removed or deposited: N/A
Statement of the effect, if any, on the wetlands and tidal
waters of the town that may result by reason as such proposed
operations (use at.!-ac .*nents if appropriate ) :
Temporary effect during jetting of pilings into wetlands
1 State Environmental Quality Review.
SHORT ENVIRONMENTAL SESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT -'SPONSOR 2. PROJECT NAME
Stanley Chase by En-Consultants, Inc.
3. PROJECT LOCATION:
Municipality Oyster Bay county Suffolk
4. PRECISE LOCATION (Street address and road Intersections,prominent landmarks,etc..or provide map)
Deep Hollow Drive, Mattituck
SCTM #1000-115-12-12
5. is PROPOSED ACTION:
to New Q Expansion [i Modif)cationtaiteration
6. DESCRIBE PROJECT BRIEFLY:
SEE ATTACHED
7. AMOUNT OF LAND AFFECTED;
Initially 10 , 2 7 5 s Q,f ig Ultimately 10 ,2 7 5 s C ,f t acres
a. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
FXYes ❑No It No.describe briefly
4. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
LN Residenvai C Industrial Commercial ❑Agriculture r-�
g C Park/ForesVOpen space 7—'Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL.
STATE OR OR LOCAL)?
IQ Yes C No If yes, list agency(s) and permiVapprovals
DOS -letter of no jurisdiction, a
11•. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes N No If yes. list agency name and permitlapproval
12. AS A RESULT�O�F PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MODIFICATION?
Q Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
AppiicantISponsor name: Stanley Chase by En-Consultants , Inc
Date:
Signature:
DENT
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
County of Suffolk
State of New York
BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) 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 2*py
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 PROPERT`_'
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
G4 ON—_0
Signature
SWORN TO BEFORE ME Tv=S �1 DAY Or
.7YAn!PlJi31.1cc,State of New Yoe"
No.39.4909M
Notary Pub!_- " ,aiaiad In Nassau Count
_. =(oji Exptres Nov.2. 1�
Date:
TO WHOM IT MAY CONCERN:
I, Stanley Chase , authorize En-
Consultants, Incorporated, to apply for permits on my
behalf.
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O R I ve5�8�95-
STATE OF NEW YORK
DEPARTMENT OF STATE
ALBANY, NY 12231-0001
ALEXANDER F. TREADWELL October 31 1995 Br
SECRETARY OF STATE � , rf
Mr. Roy L. Haje, President Nod
En-Consultants, Inc. o' �" -� 1995 �`A/1 j/
1329 North Sea Road
Southampton, NY 11968 �n1
Re: F-95-547
U.S. Army Corps of Engineers/New York
District Permit Application #10GP-95-08570
Stanley Chase
Town of Southold, Suffolk County
Dear Mr. Haje:
The Department of State has received the information you provided on October 27, 1995
describing the above proposed project.
We have been informed by the U.S. Army Corps of Engineers that your project was
authorized under an existing General.Permit. Therefore, no further review is required by
this Department.
We appreciate your referring this information to the Department of State for review.
Sincerely,
VIeaf,
William F. Barton
Chief, Consistency Review
and Analysis Bureau
Division of Coastal Resources
and Waterfront Revitalization
WFB:DM:dlb
cc: COE/New York District - Sophie Ettinger
DEC/Region 1 - Robert Greene
Town of Southold - Albert Krupski
`i RECYCLED PAPER
Albert J. Krupski,President hy�� �Gy� 5309own Main Road
John Holzapfel,Vice President
William G. Albertson y P.O. Box 1179
Z -
Southold,New York 11971
Martin H. Garrell •
Peter Wenczel y�Jpl �.a�! Telephone (516) 765-1892
Fax (516)765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 24, 1995
En-Consultants, Inc.
1329 North Sea. Road
Southampton, NY 11968
RE: Stanley Chase
SCTM #1000-115-12-12
Dear Mr. Haje:
The above referenced property was inspected and the proposed
house and construction of the house is out of Trustees
jurisdiction.
If you have any further questions, please do not hesitate to
contact this office.
' erely,
Albert J. �iup&/i'.
President, Board of Trustees
AJK:jmd
cc: Bldg. Dept.
c.,�.
Albert J. Krupski. President +Y Off' �G �� Town Hall
John Holzapfel, Vice President } 53095 Main Road
i P.O. Box 1179
William G. Albertson ,?,c
Martin H. Garrell O � r;;' Southold, New York 11971
O� Telephone 516 765-1892
Peter Wenzel .y'''Ipl �� P ( )
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO: STANLEY CHASE
Please be advised that your application, dated August 31, 1995
has bee reviewed by this Board, at the regular meeting of
Sept. 28, 1995 and the following action was taken:
( XXX ) Application Approved. (see below)
( ) Application Denied. (see below)
( ) Application Tabled. (See below)
If you application is approved as noted above, a permit fee is
now due. Make check or money order payable to the Southold Town
Trustees. The fee is computed below according to the schedule
of rates as set forth int he sintruction sheet.
The following fee must be paid within 90 days or reapplication
including fees will be necessary.
/Q
COMMENTS AND REMARKS:
Application Fee: $150.00 PAID
®CT L9
19196
COMPUTATION OF PERMIT FEES: 3' X 20' catwalk = 60' X $3 �8 ®vOQ;_F= f�
3' X 10' ramp = 30' X $3 = $
6' X 16' float = 96' X $3 =
$588.00
TOTAL FEES DUE: $588.00
�71
SIGNED:
PRESIDENT, BOARD OF TRUSTEES
BY: /
ERK, BOARD OF TOWN TR S
Town Hall
Albert J. Krupski, President
$�-A 53095 Main Road
John Holzapfel, Vice President c 1
c P.O. Box 1179
William G. Albertson Southold, New York 11971
Martin H. Garrell ® �
Peter H. Garrl o�IQ �O� Telephone (516) 765-1892
1 Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
October 2, 1995
En-Consultants
1329 North Sea Road
Southampton, NY 11968
Re: Stanley Chase
SCTM #115-12-12
Dear Mr. Haje:
The following action was taken by the Board of Town Trustees
during its regular meeting held on September 28, 1995 regarding
the above matter:
WHEREAS, En-Consultants on behalf of Stanley Chase applied to
the Southold Town Trustees for a permit under the provisions of
the Wetland Ordinance of the Town of Southold, application dated
August 31, 1995, 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 September 28, 1995, 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 complies with the standard set forth in
Chapter 37-18 of the Southold Town Code,
WHEREAS, the Board has determined that the project as proposed
will not affect the health, safety and general welfare of the
people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approves the application of
En-Consultants on behalf of STANLEY CHASE to cosntruct timber
dock a minimum of 4' above grade of marsh land a 3' X 30' fixed
catwalk extending from top fo bank as shown on survey; 3' X
10' hinge ramp; 6' X 16' float arranged in "T" configuration and
secured by (2) 8" pilings. Located Deep Hole Drive, Mattituck.
Permit to construct project will expire two years from the date
it is signed if not started. Fees must be paid, if applicable,
and permit issued within six months of the date of this
notification.
Two inspections are required and the Trustees are to be notified
upon completion of said project.
FEES: 3' X 20' catwalk = 60 s.f. X $3.00 = $180.00
3' X 10' ramp = 30 s.f. X 3.00 = 90.00
6' X 16' float = 96 s.f. X 3.00 = 288.00
588.00
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/jmd
cc: CAC
o��S�FFOL,��oG
s
� Town Hall, 53095 Main Road
Telephone
P.O. Box 1179
(516) 765-1801 Southold, New York 11971
���1 ����
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
EP 2 51995 �k h
LTL' S1v�.FF qLN �4`�r'• y'i.l'�il o'�t N
At a meeting of the Southold Town Conservation Advisory Council held
Thursday, September 21, 1995 the following recommendation was made:
No. 1299
Moved by Stephen Angell, seconded by Allan Connell, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
WITH CONDITIONS- of the Wetland Application of STANLEY CHASE
115-12-12 to construct a timber dock a minimum of 4' above grade of marsh
and 3' x 30' fixed catwalk extending from top of "bank" as shown on survey; 3'
x 12' hinged ramp; 6' x 16' float arranged in "T" formation and secured by two
(2) 8" pilings.
Deep Hole Drive, Mattituck
The Council recommends approval provided the project does not interfere or
impede the navigation in the, creek.
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
WITH PROVISIONS of the Letter of Non-Jursidiction requested by STANLEY
CHASE 115-12-12 for the construction of a one family dwelling, deck sanitary
system, driveway, which are all shown on the submitted site plan. All work to
be in excess of 75' from nearest wetland/water.
Deep Hole Drive, Mattituck
The Council recommends approval provided the applicant respects the required
buffer area during clearing and construction.
Vote of Council: Ayes: All
Motion carried.
JOINT APPLICATION FOR-PERMIT U.S.ARMY.CORPS OF ENGINEERS APPLICATION NO.
Please read ALL instructions on back before cot..',>. :.ng this application. Please type or print clearly in itch.-.—.h additional information as needed.
❑ARTICLE 9,TITLE 1,ARTICLE 43 6NYCRR 646(LAKE GEORGE RECREATION ZONE)
❑ARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) ❑6NYCRR 327(AQUATIC VEGETATION) 116NYCRR 328(FISH) 116NYCRR 329(INSECTS)
S ❑ARTICLE 1S,TITLE S 6NYCRR 608(PROTECTION OF WATERS)
T ❑For the construction, reconstruction,or repair of a DAM or other impoundment structure.
A
T
g `P Yy--S�� ❑ ❑For the disturbance of a STREAM BED OR BANKS or excavation in or fill of NAVIGABLE WATERS. ❑401 WATER QUALITY CERTIFICATION
ARTICLE 15,TITLE 15 6NYCRR 601 (WATER SUPPLY) ❑6NYCRR 602(LONG ISLAND WELL)
❑ARTICLE 1S,TITLE 27 6NYCRR 666(WILD,SCENIC AND RECREATIONAL RIVERS)
❑�A�RTICLE 24 6NYCRR 662.663(FRESHWATER WETLANDS)
[ ARTICLE 2S 6NYCRR 661 (TIDAL WETLANDS) ❑ARTICLE 346NYCRR 505(COASTAL EROSION)
F ❑SECTION 10(RIVER AND HARBOR ACT OF 1899)for structures and work in navigable waters of the U.S. ❑COASTAL CONSISTENCY CERTIFICATION
E
D ❑SECTION 404(CLEAN WATER ACT OF 1977)for disposal of dredged or fill material in waters of the U.S.
❑SECTION 103(MARINE PROTECTION, RESEARCH AND SANCTUARIES ACT)for the transportation of dredged materials for dumping into ocean waters.
1. LIST PREVIOUS PERMITIAPPLICATION NUMBERS AND DATES(If any)
2. APPLICANT IS MAN s1J�-t
Owner ❑Operator ❑Lessee ❑Municipality/Governmental Agency (Check as many as apply)
3. NAME OF APPLICANT(Use Full Name)
Stanley ase
MAILING ADDRESS TELEPHONE(Where can be reached during day)
116 Centre Island Rd. (516) 922-1808
POST OFFICE STATE ZIP CODE
Oyster Bay, NY 11771
4. NAME OF ❑Owner MA ent/Contact Person (Check one)
RoyL. Ha 'e, President, En-Consultants Inc.
MAILING ADDRESS TELEPHONE(Where can be reached during day)
1329 North Sea Road . (516 ) 283-6360
POST OFFICE STATE ZIP CODE
Southampton NY 11968
5. PROJECTIFACILITY LOCATION(Mark location on map,see Number la on reverse side)
County Suffolk I Town or city Sof'+hOid I wllayQ M-t741 fl.t c /�
STREET ADDRESS(If different from applicant)
Deep Hollow Drive,
POST OFFICE STATE ZIP CODE
Mattituck IMY 111952
6. NAME OF STREAM OR BODY OF WATER Deep Hole Creek
7. HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work without permit, include dates. 8. WILL PROJECT UTILIZE STATE LAND?
El Yes L�Nci Show work on map andlor drawings. C r�
Yes t1SINo
9. .PROPOSED USE: Private 10. PROPOSED STARTING DATE: 11. APPROXIMATE COMPLETION DATE: 12. FEE OF(NYS Permit Only)
❑ Public ❑ Commercial ASAP ASAP I S Enclosed
13. PROIECT DESCRIPTION: (e.g.quantity and type of material to be excavated,dredged or used for fill or rip rap, location of disposal sites: type of
structure to be installed: height of dam; size of impoundent; capacities of proposed water sources: extent of distribution system:etc.)
SEE ATTACHED
14. WILL THIS PROJECT REQUIRE ADDITIONAL FEDERAL. STATE AND/OR LOCAL PERMITS?
® Yes ❑ No , If yes. please list:
DOS , COE - Town of Southold Trustees
15. CERTIFICATION:
I hereby affirm that under penality of perjury that information provided on this form and all attachments submitted herewith is true to the best of my knowledge
and belief. False statements made herein are punishable as a Class A misdemeanor pursuant to Section 210.45 of the Penal Law.
Further, the applicant accepts full responsibility for all damage, direct or indirect, of whatever nature. and by whomever suffered, arising out of the protect
described herein and agrees to indemnify and save harmless the State from suits, actions, damages and costs of every name and description resulting from said
proiect. In addition. Federal Law, 18 U.S.C. Section 1001 provides for a fine of not more than $10,000 or imprisonment for not more than five years, or both.
where an applicant knowingly and willfully falsifies, conceal or covers up a material fact:or knowingly makes or uses a false. iictitous or fraudulent statement.
_. hvreov authorize the agent named in Number 4 b e to sub t pplication on my behalf
President
s" RO V L. a E3IGNATU
TITLE
PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE
PROJECT DESCRIPTION
Construct a timber dock a minimum of 4 ' above grade of
marsh and 3 ' x 30 ' fixed catwalk extending from top of
"bank" as shown on survey; 3 ' x 12 ' hinged ramp; 6 ' x 16 '
float arranged in "T" configuration and secured by (2)
8",d pilings.
Construct a one family dwelling, deck, sanitary system,
bluestone or similar pervious driveway, well, and
underground utilities, all a.s shown on attached site plan
of Van Tuyl. House will be 100± from nearest
wetland/water; sanitary system 170±. No additional fill
will be required.
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 maybe 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
LOCATION OF ACTION.(Include Street Address, Municipality and County)
NAME OF APPLICANT/SPONSOR BUSINESS TELEPHONE ^
EN-CI^.rNSULTAiNiT" jj,
ADDRESS 329 NORTH MA ROB
STATE ZIP CODE
CITYIPO
NAME OF OWNER(If-different) BUSINESS TELEPHONE
ADDRESS a f
STATE ZIP CODE
CITYIPO r i
DESCRIPTION OF ACTION
Construct a timber dock a minimum of 4' above grade of
marsh and 3' x 30' fixed catwalk extending from top of
"bank" as shown on survey; 3' x 12' hinged ramp; 6' x (2)float arranged in "T" configuration and secured by (2)
a",;� pilings.
Construct a one family dwelling,deck, sanitary system,
bluestone or similar pervious driveway, well, and
underground utilities, all as shown on attached site plan
of Van Tuyl. House will be 1o0± from nearest
Please Complete Each Question—Indicate N.A. if not wetland/water; sanitary system 170±. No additional fill
will be required.
A. Site Description
Physical setting of overall project, both developed and undeveloped areas.,;«,,,
1. Present land use: ❑Urban ❑Industrial []Commercial DResidential (suburban) []Rural (non-farm) "
El Forest ❑Agriculture ❑Other
2. Total acreage of project area: 3 acres.
APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION
Meadow or Brushland (Non-agricultural) acres acres
Forested acres acres
Agricultural (includes orchards, cropland, pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24, 25 of ECL)
• G� acres G r acres
Water Surface Area acres acres
Unvegetated (Rock, earth or fill) acres acres
Roads, buildings and other paved surfaces
acres � acres
Other (Indicate type) try`� '`' =" acres
%r' acres
3. What is predominant soil type(s) on project site?
a. Soil drainage: [FWell drained % of site ❑Moderately well drained % of site
❑Poorly drained % of site
b. If any agricultural land.is involved, how many acres of soil are classified within soil group 1 through 4 of the NYS
Land Classification System? Pr Nt acres. (See 1 NYCRR 370).
4. Are there bedrock outc'OOOIn25 on prciect Site? ,Yes ❑NO
r � -
a. N'-'a :s -cr =r. _...
5. Approximate percentage of proposed project site with slopes: 00 10% % Ell 0-15% %
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? ❑Yes MNo
7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes lKNo
8. What is the depth.of the water table? 5� (in feet) esf -
9. Is site located over a primary, principal, or sole source aquifer? Yes ❑No
10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? 1]Yes ❑No
11. Does project site contain any species of plant or animal life that is identified as threatened or endangered?
❑Yes E�No According to
Identify each species
12. Are there any unique or unusual Land forms on the project site? (i.e., cliffs, dunes, other geological formations)
❑Yes ❑"'No Describe
13. Is the project site presently used by the community or neighborhood as an open space or. recreation area?
❑Yes ISfNo If yes, explain
14. Does the present site include scenic views known to be important to the community?
❑Yes ®No
15. Streams within or contiguous to project.area:
a. Name of Stream.and name of River to which it is tributary
16. Lakes, ponds, wetland areas within or conti uous t project area:
a. Name �� b. Size (In acres) /GZ
17. Is the site served by existing public utilities? ❑Yes EhN0
a) If Yes, does sufficient capacity exist to allow connection? Eyes ❑No
b) If Yes, will improvements be necessary to allow connection? ❑Yes ❑No
18. Is the site located in an agricultural district certified pursuant to Agriculture and Markets Law, Article 25-AA,
Section 303 and 304? ❑Yes ff�No
19. Is the site located in or substantially contiguous to a Critical Environmental Area designated pursuant to Article 8
of the ECL, and 6 NYCRR 617? a es ❑No
20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes ❑Ro
B. Prajecl Descripilon
+ 1. Physical dimensions and scale of project (fill in dimensions as appropriate) _
Ia. -Total contiguous acreage owned or controlled by project sponsor acres.
b. Project acreage to be developed: �' 7 acres initially; acres ultimately.
c. Project acreage to remain undeveloped acres.
d. Length of project, in miles: -210� (if appropriate)
e. If the project is an expansion, indicate percent of expansion proposed )y %;
f., Number of off-street parking spaces existing ; proposed -3
g. Maximum vehicular trips generated per hour (upon completion of project)?
1 h. If residential: Number and type of housing units:
One Family Two Family Multiple Family Condominium
Initially
Ultimately
i. Dimensicns (in Feet; C'r :ar?est prr.cosed Structure h`ight; width; length.
j 1_:i Leeit cf „'cnta,- ilcr _ —.1-lic thorou'hfare oroiect will occucv is? ft.
3
2. How much natural material (i.e., rock, earth, etc.) will be removed from the site? tons/cubic yards
3. Will disturbed areas be reclaimed? ❑Yes ONO FT JA
a. If yes, for what intended purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? ❑Yes ONO
c. Will upper subsoil be stockpiled for reclamation? ❑Yes . ONO
4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? 1/3 acres.
5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
❑Yes ONO
6. If single phase project: Anticipated period of construction
months, (including demolition).
7. If multi-phased: Y %'
a. Total number of phases anticipated (number).
b. Anticipated date of commencement phase 1 month year, (including demolition).
c. Approximate completion date of final phase month_ year.
d. Is phase 1 functionally dependent on subsequent phases? ❑Yes ONO
8. Will blasting occur during construction? ❑Yes -SNo
9. Number of jobs generated: during construction ='' after project is complete
10. Number of jobs eliminated by this project
11. Will project require relocation of any projects or facilities? ❑Yes If yes, explain
12. Is surface liquid waste disposal involved? ❑Yes 21q-0
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? RY-es ❑No Type
14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes 'MO
Explain
15. Is project or any portion of project located in a 100 year flood plain? GYes ONO
16. Will the project generate solid waste? -EYes ONO
a. If yes, what is the amount per month tons
b. If yes, will an existing solid waste facility be used?, des ONO
c.. If yes, give name
--H- location
disposal system or into a sanitary landfill? Dyes ❑—rldo
d. Will any wastes not go into a sewage
e. If Yes, explain
17. Will the project involve the disposal of solid waste? ❑Yes [XO
a. If yes, what is the anticipated rate of disposal? tons/month.
b. If yes, what is the anticipated site life? years.
18. Will project use herbicides or pesticides? Cfes ONO
19. Will project routinely produce odors (more than one hour per day)? ❑Yes ❑
20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes Cd1Vo
21. Will project result in an increase in energy use?, Q�es ONO
If yes , indicate type(s)
22. If water supply is from wells, indicate pumping capacity gallons/minute.
.,
23. Total anticipated water u_a;e ;er day =�J gallons day.
rcje�'_ im;olye '---c a;. :--r' or Federal funding? ❑Yes �JIN
25. Approvals Required: Submittal
Type Date
City, Town, Village Board ❑Yes ❑No
City, Town, Village Planning Board ❑Yes ❑No
City, Town Zoning Board ❑Yes ❑No
City, County Health Department NYes ❑No
Other Local Agencies DYes ❑No
I����S L.r.� •t
Other Regional Agencies ❑Yes ❑No
State Agencies E'Yes ❑No 5 /
z
Federal Agencies -t7Yes ❑No
G. Zoning and Planning Information
1 . Does proposed action involve a planning or zoning decision? 01' s ❑No
If Yes, indicate decision required:
❑zoning amendment ❑zoning variance Especial use permit ❑subdivision ❑site plan
❑new/revision of master plan ❑resource management plan ❑other
2. What is the zoning classification(s)of the site?
3. What is the maximum potential development of the site if developed as permitted by the present zoning?
4. What is the proposed zoning of the site?
5. What is the maximum potential development of the site if developed as permitted by the proposed zoning?
6. Is the proposed action consistent with the recommended uses in adopted local land use plans? -E es ❑No
7. What are the predominant land use(s) and zoning classificationywithin a '/4 mile radius of proposed action?
8. Is the proposed action compatible with adjoining/surrounding land uses within a '/ mile? C-r'-es ❑No
9. If the proposed action is the subdivision of land, how many lots are proposed?
a. What is the minimum lot size proposed?
10. Will proposed action require any authorization(s) for the formation of sewer or water districts? ❑Yes
11 . Will the proposed action create a -emand for any community provided services (recreation, education, police,
fire protection)? ❑Yes Of4 o
a. If yes, is existing capacity sufficient to handle projected demand? ❑Yes — ❑No
12. Will the proposed action result in the generation of traffic significantly above present levels? ❑Yes 2f4o
f a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes ❑No
Y9
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
I certify that the information provided above is true to the best 6f my knowledge.
! Applicant/Sponsor dame Date
Signature '' f Title
1f 1'he i5 1n Oc5"ill . . '3. J::u :" 1 c:inplete the Coastal .Asses-sm.ent Form be-fore proceeding
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WELL j SUFFOLK CO. TAX MAP DESIGNATION:
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„a* t.t.-t. j DIST. SECT. BLOCK PCL.
C I 1000 1.15 12 12
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DEED: L,2992 P. 41.7(2EE
TEST HOLE j STAMP
tfnauthod2ed alterailon oraddRPm
to this survey Is a violation of
�,� U5 Section 7208 of the New York State
Education Law
TC?P a0 I L. c Copies of this survey map not beating
the land surveyor's inked seal or
embossed seal shall not be considered
MAP. OF P 2 Q P E RT Y NOTE* GAt D Y to be a valid true copy.
ELE'VAMO"S' QEFEQTO MEAN SEA LEVE.L,WGV D, LY?AM Guarantees indicated hereon shall run
Si 1 v���n inn --- t ontytpar the
.andonhisbeh the ftothe y
v dA rV`` 2 Is prepared,and on his behalf to the
title company,governmental agency and
EY tending institution listed hereon and
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L� ,, 1 }� I tution.Guarantees are not transferable
-- SAt�!(7 to additional institutions or subsequent
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LICENSED LAND SURVEYORS SFO LAND `�JP
GREENPORT NEW'YORK
YNE POST N81329