HomeMy WebLinkAboutTR-4193 Amend Qg13FFO(,�c
Albert J. Krupski,President �0�. OG Town Hall
John Holzapfel, Vice President = y` 53095 Main Road
�William G. Albertson - �'
P.O. Box 1179
'�Martin H. Carrell Southold, New York 11971
O • �
Peter Wenczel �f'jJpl ��0� Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 30, 1995
Richard Mautner
2055 Bayshore Rd.
Greenport, NY 11944
Re: SCTM #53-4-12
Dear Mr. Mautner,
The following action was taken by the Board of Trustees at their
regular meeting of June 29, 1995:
RESOLVED that the Southold Town Board of Trustees approve an
Amendment to Permit #4193 to construct a 20 ' X 35 ' deck to an
existing house as per revised survey dated May 15, 1995.
If you have any questions, please call our office.
Very truly yours,
Q n �
Albert J. KKrupski, Jr.
President, Board of Trustees
AJK/djh
cc. CAC
Bldg. Dept.
ti \ y
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Y �� � �.y�.�.�.> •'�_ +�Sr J' _ !'�aC•'�' � � ;ram' s'�k�`_rFa^�,1"',:'��."'s��'S�i.'�!yr,.` -
Board Of Southold" Town Trustees
1 -t SOUTHOLD, NEW YORK
jh
PERMIT NO. ....4.].9..3.... ............... DATE: ...June...2.5.,....1993 �
<<_
ISSUED TO ........Richard Mautner...............................................................................
\ ''i`• 1� Pursuant to the' provisions of Chapter 615 of the Laws of
1 " » 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 AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the jw� '
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM k
wi LANDS UNDER TOWN WATERS;" and in accordance with the
s,.
Resolution of The Board adopted at;a meeting held on ...J.une...2..4.....
:
sum of 19.....93.., and in consideration of the $......150.,.00..... paid by
.................. ...�xc.hax.d...Ivi.a..utrxex........... ................................. ............................... l'
J!
of ................................................................. ...... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following: - «
fi to rebuild storm damaged lawn retaining wall (approx. 3 High)
and move this wall to match existing wall of adjacent Neighbor.
a1. � f
1\, �' �t:� SFr •i
ti all in accordance with the detailed 'specifications as presented in
the originating application. . ss
IN WITNESS WHEREOF, The said Board of Trustees here- i".
by causes its Corporate Seal to be' affixed, and these presents to
be subscribed by a majority of the said Board as of this date. 11«,
,z ............... ...........
_tsb
.......................... 1,'
•; of � �,a ,•k
.TeS
I =
t .f.?fw, •'L.s.o.a�n�,. s •^.�.,.:IPi':'*r5a,•rl�..,l.y; ° d i...aT .6.. .r It_-is�' .it p✓A :( yi "�nat^�iF.A!* e+t �IV I'
ERVISOR
John M. BredemeTyerEIII, President
O�pSVFFO(�CO SCO PT L. HARRIS
y. G T
Albert J. Krupski, Jr., Vice President y1.
Henry R Smith y Z Town Hall
John B. Tuthill O 53095 Main Road
William G. Albertson 'r•�j�l p� P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 30, 1993
Richard Mautner
2055 Bayshore Road
Greenport, NY 11944
Re: SCTM #1000-53-4-12
Dear Mr. Mautner:
The following action was taken by the-Board of Town Trustees during
its regular meeting held on Thursday, June 24, , 1993 regarding the
above matter:
WHEREAS, applied to the Southold Town Trustees for a permit under
the provisions of the Wetland Ordinance of the Town of Southold,
application. dated April 15, 1993 ana,
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 Thursday, June 24, 1993 at which time all
interested persons were given an opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are familiar
with the premises in question and the surrounding area, and,
WHEREAS, the Board has considered all the testimony and documentation
submitted concerning this application, and,
WHEREAS, the Board has determined that the project as proposed will
not affect the health, safety and general welfare of the people of
the town,
NOW, THEREFORE BE IT
RESOLVED that the Board of Trustees- approves the application of
Richard W. Mautner to rebuild storm damaged lawn retaining wall
(approx. 3 ' high) and move this wall to match existing wall of
adjacent neighbors.
Permit will expire two years from the date it is signed. 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.
Permit will be issued upon payment of the following fees for work to
be do below Mean High Water Mark:,
Town.Hall, 53095 Main Road
v' T P.O. Box 1179
Telephone w
(516) 765-1801 �� ��' Southold. New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
y 2 619M
TO: Southold Town Board of Trustees TOWN OF SOUTHOLD
FROM: Southold Town Conservation Advisory Council
DATED: May 24, 1993
RE: Recommendation of Applications
At the May 20th 1993 meeting of the Southold Town Conservation
Advisory Council, the follow recommendations were made:
Moved by Bruce Loucka, seconded by Betty Wells, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
of Wetland Application of GEORGE BRAUN 53-4-11 to rebuild
storm damaged lawn retaining wall (approximately 3' high) and move
the wall approximately 6' out to be in line with neighboring property
-walls. .
2005 Bayshore Road, Greenport.
Vote of Council: Ayes: All
Motion carried.
Moved by Bruce Loucka, seconded by Betty Wells, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
of Wetland Application of ,RICHARD MAUTER 53-4-12 to rebuild
storm damaged lawn retaining wall (approximately 3' high) and move
wall to match existing wall of adjacent neighbors.
2055 Bayshore Road, Greenport
Vote of Council: Ayes: All
Motion carried.
Moved by John Holzapfel, seconded by Bruce Loucka, it was
RESOLVED to recommend to the Southold Town Trustees APPROVAL
of the Wetland Application of NUNAKOMA WATERS ASSOCIATIONS,
INC. 87-2-40.1 & 40.2 to construct a timber retaining wall 170 +/-
I.f. overall (including returns) generally at or above line of
apparent high water and backfill with 170 +/- c.y. of clean sand to
be trucked in from upland source. Wall is necessary to prevent
June 21, 1995
t�.
300' x 100'. New pond to be connected to old pond (on northern edge), 20'
connector, with a 40' berm in the middle as shown on submitted plans.
Narrow River Road and Platt Road, Orient
Vote of Council: Ayes: All
Motion carried.
No. 1276
Moved by Bruce Loucka, seconded by Stephen Angell, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL
WITH CONDITIONS of the Wetland Application . of DAVID CICHANOWICZ
66-3-16 to construct a fixed open walkway 3' x 35'; hinged ramp 3' x 161; two
floating docks, each 6' x 20'; and install three 2-pile dolphins to secure
floating docks.
The CAC recommends approval provided that application reduce the project
to ONLY ONE 6' x 20' FLOAT. Also the catwalk should be 3' wide and
elevated to 3' above the grade.
Vote of Council: Ayes: All
Motion carried.
RECOMMENDATION OF AMENDMENTS
A-15
Moved by Stephen Angell, seconded by Betty Wells, it was
RESOLVED to recommend to the Southold Town Board of Trustees
DISAPPROVAL of the Amendment Request of RICHARD MAUTNER 53-4-12 to
construct a 20' x 35' deck addition to existing home.
The Council recommends disapproval `of this as an amendment. The project
does not amend and is out of the scope of the permit issued. The Council
recommends that the Trustees require that Mr. Mautner apply for .a permit for
the deck. The CAC would recommend approval for that permit.
2055 Bayshore Road, Creenport
Vote of Council: Ayes: All
Motion carried.
SOUTHOLD TRUSTEES
No.
Issued To_ & b&a:6%i Dated
Ad,dress
THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
SUFFO(,�
Albert J. Krupski, President ; p�� CG'G Town Hall
John Holzapfel, Vice President o� Y y� 53095 Main Road
William G. Albertson P.O. Box 1]79
,s• Southold, New York 11971
Martin H. Garrell
Peter Wenczel j'®� �,�®� Telephone (516) 765-1892
It Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
office Use Only
Coastal Erosion Permit Application
Wetland Permit Application
Grandfather Permit Application
Trustee Lands Per it pplication
Received vApplication: S' '� _ �`
Clerical Review:
Completed Application g 141
Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination: (date*setCAC Referral Sent:
Date of Inspection S'Receipt of CAC Repte).Lead Agency Determination: ZiRs a
Fr
Technical Review: (date) 4 _
Public Hearing: (date) 6 .2 S'
Decision: Approved (Y/ ) date)
Application Fee:$
Name of Applicant: \
G
roo(c
Address ►u IIJ� 3
Phone Number: W6-
Suffolk County Tax Map Number: 1000 - S3 - Z-
Property Location:
Lk )\12- �3
(provide LILCO Pole # , distance to cr sss streets, and location)
Agent:
_.�� ��� �:: - e-
( If appcab )
Address: 1�J5'l� �cx--i,UZJ 1✓�, c�c�l� 1�1ci,
Phone:
1
Bc 3 of Trustees Application
GENERAL DATA
Land Area (in square feet) :
Area Zoning:
Previous use of property: re's (C)u)f f cc
Intended use of property: Rd i�-e.()4-i e(-1
Prior permits/approvals for site improvements:
Ag2ncy Date --
own rnmi
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
jl No Yes
If yes, provide explanation:
Project Description (use attachments if necessary) :
2s ` C�e-c�� cx.c C ch y t\-)
to -h f\' 0m e_--
2
Bi d of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
I, residing at
(print owner of property) (mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(Owner' s signature)
4
Bo of Trustees Application
County of Suffolk
State of New York
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 DAY OF )72p— ,19
tary Public
JOYCE M.WiLKINS
Notary Public,State of New York
No.4952246,Suffolk Coun
Term EViree June 12,1 un
3
Boy of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: f'GS N d'en
Are wetlands present within 75 feet of the proposed activity?
j( No Yes
Does the project involve excavation or filling?
X No Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts
reasonably anticipated resulting from implementation of the
project as proposed. (Use attachments if necessary)
nDC1L'/
5
Boa of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: M'S
Area of wetlands on lot: C«,r-, square feet
Percent coverage of lot: o
Closest distance between nearest existing structure and upland
edge of wetlands: 1] V feet
Closest distance between nearest proposed structure and upland
edge of wetlands: i SZ ° feet
Does the project involve excavation or filling?
No Yes
1
If yes, how much material will be excavated? cubic yards
How much material will be filled? cubic yards
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area of operations: f) O(U—
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlands and tidal
waters of the town that may result by reason os such proposed
operations (use attachments if appropriate) :
n D r�
6
14.16.4(2/87)—Text 12
PROJECT I.D. NUMBER 617.2 r SEW
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR n�r� `� � �. � 2. PROJECT NAME
fah n /u{ 1
3. PROJECT LOCATION:
Municipality V C p(i— County
4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map)
a its-ems h o
5. IS PROPOSED ACTION:
El"New ❑Expansion ❑Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
�4' d e 'J-L o rJ
7. AMOUNT OF LAND AFFECTED:
Initially i,Z acres Ultimately !�Z' acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
L�+IYes ❑No If No,describe briefly
9. WHAT PRESENT LAh:r7 USE IN VICINITY OF PROJECT?
Residential ❑!ndustrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATES OR LOCAL)?
2 Yes ❑No If yes, list agency(s)and permit/approvals
11. DOES ANY ASP T OF THE ACTIO14 HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes RI No If yes, list agency name and permit/approval
12. AS A RESULT OF ROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicanllsponsor name: n '"er 'v (I e11 Dale:
Signature:
If the action is in the Coastal Area, and you are a state agency, complete the
Coastal Assessment Form before proceeding with this a_�.§essment
OVER
PART II—GNVIRONMENTA4 �SESSMENT (To be completed by Agenc!
A. DOES ACTION EXCEED ANY',; I THRESHOLD IN 6 NYCRR, PART 617.12? If yes,coordinate the review process and use the FULL l3AF.
❑Yes ❑No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration
may be superseded by another Involved agency.
❑Yes ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten, If legible)
Ct. Existing air quality, surface or'groundwater quality or quantity, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion,drainage or flooding problems?Explain briefly: -
C2. Aesthetic,agricultural,archaeological, historic, or other natural or cultural resources;or community or neighborhood character? Explain briefly:
C3. Vegetation or fauna, fish,shellfish or wildlife species,significant habitats, or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land or other natural resources?Explain briefs �p y.;
C5. Growth, subsequent development,or related activities likely to be induced by the proposed action? Explain briefly.
C6. Long term,short term,cumulative,or other effects not identified in CI-05? Explain briefly.
C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly.
D. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it Is substantial,large,Important or otherwise significant.
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability Of Occu;dng; (C) duration; (d)
Irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that
explanations contain sufficient detail to show that all relevant adverse impacts have been Identified and adequately addressed.
7Check
this box if you have identified one or more potentially large or significant adverse impacts which MAY
Then proceed directly to the FULL EAF and/or prepare a positive-declaration.
this box if you have determined, based on the Information and analysis above andany supporting
Fentation, that the proposed action WILL NOT result in_ ny significant adverse environmental impactspovide on attachments as necessary, the reasons supporting this determination:
Name of Lead Agency
f',,nl or type Name of Responsible Ufficer.n Lead Agency
Title of Responsible Officer
Signature of Responsible Officer m Lead Agency Signature of f'reparer Or different from responsible orfrcer)
Dalc
2
k r
TRUSTEES a ' , � da - ~
er III President � SUPERVISOR
John M. Bredeme
y SCOTT L.HARRIS
Albert J. Krupski, Jr., Vice President
r `
Henry R Smith Town Hall
John B. Tuthill 53095 Main Road
William G. Albertson ' ✓ ,. � P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only: DATE REC. :
� Coastal Erosion Permit Application
t 'Coastal Erosion Variance Application M
Wetland. Permit Application U
aiver from Chapter 97 (Application/pe
oWrustee Lands Permit Application �eD _ T
Grandfather Permit Application Ps'��
Completed Apps. Date: ,
Inspection date:I4-zl(3 TOWN OF SOUTHOLD
,t-6AC comments-Date: Sent�_Rec
Itariance Required: (YIN)
eighbors notified-Date:
SEQRA Type
Coord. : Date sent-yam L0/-S&,r`weke`^A_
SEQRA Determin./date:
Public Hearing/date:
Findings: Approved (YIN)
Special Conditions: (YIN)
(see file) Application Fee:
Permits) issued-date: S l a /f/11 7j !1n-,,
Application Number;SCTM#1000- '�, ""��- Date: 3
Applicant: / C A 642 W MoO�'
Address: KS16f0,20-r` leol b � - U G���G
Phone (fie) �'-ZZ
Interest: (owner, consultant,lessee,etc. ) 6)bJ1Vt=-14
Owner of Property: -54";?ug- AT 14'a
Address v!
Phone ( )
Subject Property Location: S4,off4x- I#S- 4,86014F
(Provide LILCO Pole #, Distance to' cross Streets if not on
location map)
THIS IS NOT A PERMIT Page 1
Yds. to be excavated: — — Yds. to be Filled.: ` L'
Manner in which material will be removed or deposited:
Width of canal, creek or bay fronting property:
Depth at low tide: IV IA Aver. rise in tide: N �
Distance to nearest channel: 60��4CT %0 Distance project
extends beyond similar projects in area: t i d" W J11t
W 4 Lc-s
Area zoning: ,&s(.b(,,:- ►t/ �- Land area in acres: Y�?, 4c,2�r
Is project for private or business use: 1//,; 7"/r-
Intended use of property: /-�L+s+ c�i�lf/ � �r���`t�'f�'r�►/'� �c�
Describe known prior operations conducted on premises:
Has any prior license or permit been issued to erect structures,
dredge, or deposit fill on said premises:
Has any license or permit ever been revoked or suspended by a
Governmental Agency: /V 0
Project Description
The project description must also include plans for reclamation
of land disturbed during construction of the principle and
accessory structures and underground structures (i.e. , pipeline
and septic system; make additional attachments if necessary) .
'<4,'Q y t L-1� s r'o s rpt �Mmy,4r'c;�J+ L,4u-9,L� r:to 7w)...',.,d G tAj..t/
THIS IS NOT A PERMIT •Page 2
Authorization (Where the applicant is not the owner)
I �XtA,0 Lj c� s67rs f d<rrZresiding at 60 /,G Vox 4vCF-
(Print-owner of subject property) (Mailing address-phone)
ST6-Y
do hereby authorize R&&F-A7— CAUF'60-d_f',S_ -to apply for
Coastal Erosion permit(s) from the Southold Town Trustees
Signature
THIS IS NOT A PERMIT P.age: 3
14-4.e-4(2/87)—Text 12
., '• PROJECT I.D.NUMBER o 17.21 SEW
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT/SPONSOR 2. PROJECT NAME
G-414A- tj S'VAv i'va-iz �G'T 41AW &d.411 441C0.rl5r vc 7-oaf-
3. PROJECT LOCATION:
Municipality GA "S•'s 14.9A r' County YJf-Fof-1<
4. PRECISE LOCATION(Street address and road intersections,prominent landmarks,etc.,or provide map)
5. IS PROPOSED ACTION:
❑New ❑Expansion Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
(J -
�/#
t"u'1z i kc-,z e(?f `ra 8 cr
—
7. AMOUNT OF LAND AFFECTED:
Initially 411A acres Ultimately A acres
8. WILL PROPOSED A TION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
OYes ❑No If No,describe briefly
I
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
•Residential ❑!ndustrial ❑Commercial ❑Agriculture ❑Park/Forest/Open space ❑Other
Describe:
10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATE OR LOCAL)?
❑Yes XNo If yes,list agency(s)and permit/approvals
ti
11. DOES ANY ASPECT OF THE ACTIO14 HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
❑Yes �to If Yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes ❑No
CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name 1�2� ��/ �/i?/(,�� Date:
\ Signature:
\ �61 eir*�f
I
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
I I I.+L fv f HL ��J�c ;F.1EN I (F o De comPI(!Ied by Agency)
A. DOGS ACTION:E�(�- - E I THRESHOLD IN 6 NYCRR, PART 617,12? It I oordlnato the review proCoss and use ICa FULL-
❑Yes E%AF
8. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? -------
mayr
be superseded by another involved agency. If No,a negative declaration
❑Yes ❑No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED.WITH THE FOLLOWING:(Answers may be handwritten,if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existingtraffic patterns, solid waste
potential for erosion,drainage or flooding problems?Explain briefly: P production or disposal,
C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources; or community or neighborhood character'? Explain briefly:
C3. Vegetation or fauna, fish,shellfish or wildlife species,significant habitats•or threatened or endangered species?Explain briefly:
C4. A community's existing plans or goals as officially adopted,or a change in use or Intensity of use of land or other natural resources?Explain briefly.
C5. Growth,subsequent development,or related activities likely to be induced by the proposed action? Explain briefly.
C6. Long term, short term,cumulative,or other effects not identified in C1"C5? Explain briefly.
C7. Other impacts(including changes in use of either quantity or type of energy)? Explain briefly.
D. IS THERE.OR IS THERE LIKELY TO BE.CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
❑Yes ❑No If Yes,explain briefly
PART III—DETERMINATION OF SIGNIFICANCE
(To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,lar
Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); b ge,important or otherwise significant.
irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference Supporting of Occurring;
materials. Ensure that
occurrin
explanations contain sufficient detail to show that all relevant adverse impacts have been identified and g' (c) duration; (d)
adequately addressed.
❑ Check this box if you have identified one or more potentially large or significant adverse impacts which �.
occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. MAY
❑ Check this box if you have determined, based on the information and analysis above and an Supporting
documentation, that the proposed action WILL NOT result in any significant adverse envirOn
AND provide on attachments as necessary, y pp rung
the reasons supporting this determination: mental impacts
Name rn LeaJ ngcney
Yrmt ur 1VPe Name of Keipunsrbfe Uli cer in Lead Agency•
title of Kesponitble UIIKer
�orgnature of HKiponsrble Cltricer in lead Agency
- Signature br 1'reparer lit different from responsible otticer
1
Date
z
County of Suffolk )
State of New York )
R/C.AAP-D UJ M/9 UT/JF/� 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 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 REPRESENTATIVE(s) , TO ENTER ONTO MY PROPERTY
TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS
APPLICATION.
SIGNATURE
SWORN TO BEFORE ME THIS DAY OF Atard 11913
NOTARY PUB IC
PAULINE L BMrfH
Notary Public;State of NoMt Y tIt
No. 31.46m734
Quallfled In New York Gou* '
Oammiseifn ExPires August 31;14WIqc13
i
Suggested space for location Map
THIS IS NOT ,A PERMIT
TRUSTEES SUPERVISOR
John M. Bredemeyer, III, President � ' SCOTT L.HARRIS
Albert J. Krupski, Jr., Vice President ' Acv_,{.
HenryP. Smith F Town Hall
( ,.
John B. Tuthill f �>.� . 53095 Main Road
William G. Albertson P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
30 year Maintenance Agreement
Erosion Protection Structures
Chapter 37 Southold Town Code
Southold Trustees as Administrator
I (we) !cA/,5} /24Z W . /1?,�9u7-nJc--/e-
type or print name(s)
the owners of record of property at• ,O 57-s 134
�✓��si�JPor2 T /V 1/ </9 yy
(type or print str et address) SCTM 41000-
in applying for a Coastal Erosion permit for an Erosion
Protection Structure do hereby agree to a 30 year maintenance
program for a structure commonly known as a I,A WV
of iCi1--7'1/ ?�4 as shown on the attached
feet of length
licensed survey of the as-built structure.
It is my/our understanding that we are to maintain this
structure with materials designed to endure 30 years and or
equivalent to the original approved structure and that for any
maintenance which involves more than 5% in length of this
structure we are to give prior written notice to the
administrator, waiting for their approval in all but true
emergency situation' s which would seriously endanger life,
property and important coastal natural resource features such as
bluffs or wetlands. We further understand that failure to
maintain the structure could result in a requirement to post a
bond and or have the repairs ordered as a lien against the
property upon a finding by the Trustees that said lack of
maintenance would risk life, property or important natural
resources features including protected, rare or threatened
animals and plants.
Notarized Signature of owner of record
I
SWORN TO BEFORE ME THIS Sfi DAY OF 19g5
PAULINE L SA n*H
OTARY PUBLIC � state No. 31- 3 of
Yodj
ouawled In Nam York Cous►iy
Commission Expires Augwt 31,1896?1413
Please submit three copies of a licensed land survey made within
one year of the original construction. -This maintenance
agreement shall only be valid upon the final approval of the
administrator. Subsequent owners may apply to the Southold Town
Trustees to re-authorize this maintenance agreement.
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114,
Richard W. Mautner
60 Lenox Avenue
Lynbrook, New York 11563
f Phone (212) 599-4700
Fax (212) 983-7073
May 191995
Q 0
May 17, 1994
To Whom it May Concern:
Re: Private Residence
2055 Bayshore Road
Greenport, New York 11944
This letter will confirm that I am the owner on record of the subject property located on
Bayshore Road.
I hereby authorize Mr. John Bertani to act on my behalf in obtaining any permits, or
approvals necessary for the construction of the proposed addition to the house.
Sincerely,
Richard W. Mautner
CC: John A. Bertani,President
John Bertani Builders, Inc.
� G N`� : .
/99
notaryPA NE L SMRH
PUbliaNa 31 StateNow Yo
�34 rk QuelMed In New York County
COMMIM on"res Auqust 31.tWA 1994-
New York State Department of Environmental Conservati AUG 9 1994
Building 40 - SUNY, Stony Brook, New York 11790-235
Phone (516) 444-0295 n
Fax # (516) 444-0349 T�WIV - SOUTHOLD
Langdon Marsh
Commissioner
Notice of Violation
July 29, 1994
Mr. Richard Mautner Mr. George Braun
60 Lenox Avenue 7 Huron Rd.
Lynbrook, NY -11563 Bellerose Village, NY 11001 t
Date of Violation: on or before July 29, 1994
Location of Violation:2005 Bayshore Rd., Southold Tax Map ID # 1000-53-4-11 & 12
Permit # (if applicable)
Dear Mr. Braun:
i
Records of this Department indicate that you are in violation of the Environmental Conservation
Law (ECL):
i
�—� Article 15, Protection of Waters
Section 6NYCRR
i�
�--� Article 15, Wild, Scenic and Recreational !Rivers Act
Section 6NYCRR
LJ Article 23, Mined Land Reclamation Law
Section 6NYCRR
�--� Article 24, Freshwater Wetlands Act I
Section 6NYCRR
LX--J Article 25, Tidal Wetlands Act
Section 25-0401.1 6NYCRR Part 661
�—� Article 19, Air Pollution Control Act (Restricted Burning)
Section 6NYCRR
i
In that you caused, or permitted to be caused: construction)of approximately. 100' of rail road tie retaining
wall in the area adjacent to a regulated tidal wetland without the necessary NYSDEC permit.
t;°
- t
Contravention of this/these Article(s) of the ECL is a violation and/or a misdemeanor punishable by
a fine of no more than /a day. Penalties may be assessed for each day that the violation continues.
Please be further advised that violations of the ECL which are not resolved may be the subject of an
administrative hearing pursuant to Title 6 of the Official Compilation of Codes, Rules & Regulations of the
State of New York (6NYCRR, Part 622).
You are hereby advised to cease your operation at the referenced location immediately.
Please contact the following office within thirty (30) days of receipt of this letter, so that we may
attempt to resolve this matter. Failure to contact this office within this time period will result in this matter
being referred to the Department's Regional Attorney for further enforcement action.
To schedule an appointment for a compliance conference in this matter, please contact Ms. Kay
Worker at (516) 444-0295.
Office of Legal Affairs Attn: Gail Hintz
Assistant Regional Attorney
Very truly yours,
Charles T. Hamilton
Regional Supervisor of
Natural Resources
Stony Brook
cc: Regional Attorney
Dr. Christopher S. Mallery, ACOE
ECO Enright
Certified Mail # go a / .7��i �f 9
NOV# 94LC132
j
' I
New York State Department of Environmental Conservation
Building 40—SUNY, Stony Brook, New York 11790-2356 M
AUG 9 1994
Thomas C. Jorling
TOWN OF SOUTHOLD Commissioner
Notice
As required by law, the Department of Environmental Conservation is
hereby providing you with notice of an alleged violation of the
Environmental Conservation Law which occurred within your
municipality.
I ,
THIS NOTICE DOES NOT REQUIRE ANY RESPONSE OR ACTION BY YOU.
i
Please be advised that the Department has sufficient evidence to commence an enforcement
action against Q�c�a�a i �aJ�n�- GeerraQ ���.� for a violation of Article(s) 25
and/or 15 of the Environmental Conservation Law!of the State Of New York.
NOTICE PROVIDED TO:
Name: The Honorable Albert Krupski, Jr.
I
j
Address: President, Board of Trustees
Town Hall
i
P.O. Box- 1179
Southold, NY 11971-0959 -
i
NOTICE PROVIDED BY:
i
Name: Louis A. Chiarella
Title: Regional Manager - Bureau of Marine Habitat Protection
Date
I
r '
o� BUFFO( OG _.,
TRUSTEES O �C SUPERVISOR
John M. Bredemeyer, III, President h� y SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President c
Henry R Smith c ,? Town Hall
John B. Tuthill • 53095 Main Road
William G. Albertson y?1p1 �a0� P.O. Box 1179
Telephone (516) 765-1892 Southold, New York 11971
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
S.E.Q.R.A.
NEGATIVE DECLARATION
NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT
APPLICATION NO. 1000-53-4-12 Chapt. 97 - Wetlands
NAME: Richard W. Mautner Chapt. 37 - Coastal Erosion
DATE: May 26, 1993
RESOLVED that pursuant to Article & of the Environmental Conservation
Law, State Environmental Quality Review and 6NYCRR Part 617,
Section 617.10 and Chapter 44 of the Code of the Town of Southold,
notice is hereby given that the Southold Town Trustees, as Lead
Agency for the action described below, has determined that the
project will not have a significant effect on the environment.
Please take further notice that this declaration should not be
considered a determination made for; any other department or agency
which may also have an application pending for the same or similar
project.
TYPE OF ACTION: Type I
DESCRIPTION OF ACTION: Applicant proposes to rebuild storm damaged
lawn retaining wall (approx. 3 ' high) and move this wall to match
existing wall of adjacent neighbors. Located 2055 Bayshore Road,
Greenport.
LOCATION: SCTM 41000-53-4-12
I
REASONS SUPPORTING THIS DETERMINATION:
1. An on site inspection has been conducted by the Board of
Trustees.
2.. An environmental assessment, submitted by the applicant and
reviewed and completed by the Board of Trustees, has indicated that
no significant adverse effects to the environment are likely to occur
should the following mitigation measures be implemented.
i
cc: CAC
I
i
TRUSTEES �SUfFO(,�c SUPERVISOR
John M. Bredemeyer, III, President �� OG SCOTT L. HARRIS
Albert J. Krupski, Jr., Vice President
Henry P. Smith y Town Hall
John B. Tuthill %�s 53095 Main Road
William G. Albertson y o�� P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823 BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
May 10, 1993
Mr. John Holzaphel, Chairman
Southold Town Conservation Advisory Council
Southold Town Hall
Main Road
Southold, NY 11971
Dear Mr. Holzaphel:
Transmitted herewith are the following applications for a wetland
permits :
George Braun 53-4-11
Dick Mautner 53-4-12
'Nunnak6ma Waters Assoc. 87-2-40.1 &40. 2
John Doroski 34-1-3
Cleaves Pt Village 38-7-4. 2,8
Frances McLaughlin 94-1-3
William Edgett 115-12-3
Sheldon Salzman 71-1-5
Arthur Toan 52-2-22
Strongs Marina 122-9-6. 2
Sandra Zatarian 31-16-8
Please prepare a written report of findings and recommendations
with respect to this application.
Very truly yours,
i
John M. Bredemeyer, III
President, Board of Trustees
JMB:jmd
I
t ,
Now York State Department of Environmental CoAim
a
T— SCUT Thomas C. Joriing
l' �OID Commissioner
/ CIAAC (4 07 / 5� 7-3
Dear rZ0/7�/F �1'-fA-
RE: LEAD AGENCY COORDINATION REQUEST
The purpose of this request is to determine under Article 8 (State Environ-
mental Quality Review - SEQR) of the Environmental Conservation Law and 6 NYCRR
Part 617 the following:
I
1. Your agency' s interest in acting as 'lead agency;
2. Your agency's jurisdiction in the action described below; and
3. Issues of concern which your agency !believes should be evaluated.
Enclosed is a copy of the permit application and a completed Part 1 of the
Environmental Assessment Form to assist you in responding.
Project Name: � r � �( � A ' ,
Project Location: o fi- Z J2 /I 0
DEC Project Number: `3 U v S 3 j
DEC Permits:
T 6, 7-L
SEQR Classification: ] Type I [ ] Unlisted
DEC Contact Person: .
DEC Position:
[ ] DEC has no objection to your agency or another agency assuming lead agency
status for this action, but. reserves the; right to comment on this action if
a positive determination of significance is made.
-2-
K—DEC has no objection to your agency or another agency assuming lead agency '
status for this action, but we have the following concerns regarding this
project (see "comments" below) .
[ ] DEC wishes, to assume lead agency status for this action.
[ ] The proposed action has been identified by DEC as occurring wholly or
partially within or substantially contiguous to a critical environmental
area (CEA) that was designated by
It is the position of this Department that your agency, if it has a juris-
diction over the action, should assume the lead agency role based on the
existence of the CEA and the fact that the anticipated impacts are
primarily of local significance.
[ ,] Other. (See comments below) Y
Comments (Optional ) :
Response:
Please respond. to this request within 30 ,days of the date of this letter. .
If no response is received within 30 days, weiwill assume that you have no .
objection to DEC or another agency assuming the role of.lead agency, and have no
comments to offer regarding the proposed action at this time. If neither your
agency nor any other involved agency, including DEC, has indicated a will-
ingness to serve as lead agency within 30 days of this letter:
We will petition the Commissioner of DEC to designate a lead agency
for this action.
[ ] We will petition the Commissioner of DEC to designate your agency as
lead, presuming you have jurisdiction.
Please feel free to contact this office for urther information or
discussion.
Sin e ,
i
lr
Enclosures
cc: (see distribution list)
95-19-4(4i91)-7e I DEC APPLICATION NUMBER -C 6 �
NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION �. 7 b/
csc �--
r IMY CORPS OF ENGINEERS APPLICATION NO.
_-� JOINT APPLI __ _TION FOR PERMIT
Please read ALL instructions on back before completing this application. Plus?type or print clearly in ink.Attach additional information as needed.
GARTICLE 9, TITLE 1,ARTICLE 43 6NYCRR 646(LAKE GEORGE RECREA"Llra ZONE)
[IARTICLE 15,TITLE 3(AQUATIC PESTICIDES CONTROL) 06NYCRR:.i (AQUATIC VEGETATION) ❑6NYCRR 328(FISH) ❑6NYCRR 329(INSECTS)
S. ❑ARTICLE 15,TITLE 5 6NYCRR 608(PROTECTION OF WATERS)
T
❑
A For the construction, reconstruction, or repair of a DAM or other im,,D-indment structure.
T ❑For the disturbance of a STREAM BED OR BANKS or excavation in r:.'iil of NAVIGABLE WATERS. 0401 WATER QUALITY CERTIFICATION
E ❑ARTICLE 15,TITLE 15 ❑6NYCRR 601 (WATER SUPPLY) ❑5P''1CRR 602(LONG ISLAND WELL)
El ARTICLE 15,TITLE 27 6NYCRR 666(WILD, SCENIC AND RECREATION;n'iJi!VERS)
❑ARTICLE 24 6NYCRR 662, 663(FRESHWATER WETLANDS) ❑ARYP LC:36 6NYCRR 500(FLOODPLAIN MANAGEMENT)
�RTICLE 25 6NYCRR 661 (TIDAL WETLANDS) ❑ARTICLE 34 6NYCRR 505(COASTAL EROSION)
--------=-----------------------------------------------------------------------------------------------------------------------------------------
F ❑SECTION 10(RIVER AND HARBOR ACT OF 18,39)for structures and work in navigable waters of the U.S. ❑COASTAL CONSISTENCY CERI IFIC^,TION•
E ❑SECTION 404(CLEAN WATER ACT OF 1977)for disposal of dredged or fill material in waters of the U.S.
D
❑SECTION 103(MARINE PROTECTION, RESEARCH AND SANCTUARIES ACT) for the transportation of dredged materials for dumping into ocean waters.
1. LIST PREVIOUS PERMIT/APPLICATION NUMBERS AND DATES(If any)
2. APPLICANT IS AIAN
• I�10wner D.Operator ❑Lessee ❑MunicipalitylGovernmental Agency (Check as many as apply)
3. NAME OF APPLICANT(Use Full Name) n
MAILING ADDRESS I'EL HONE(Where can be reached d ring day)
I � ) 5 - 5-6
POST OFFICE STATE ZIP CODE
4. NAME OF ❑ `
Owner KgentlC ntact Person .(Check one)
h �� i
MAILING ADDRESS TELEPHONE(Where can be reached dung day)
POST OFFICE TATE ZIP CODE
5. PROJECT/FACILITY LOCATION(Mark location on map, see Number 113 on reverse side)
County 5 q F- F G L- kT - I Town or city _D n u—'• L_ Village J�j �: '� —
STREET ADD-IRESS(If different from appliicaannt)
�- C�
POST OFFICE r STATE iZIP COLD`
6. NAME OF STREAM OR BODY OF WATER<��S-l� _
1 C C Cv
7. HAS WORK BEGUN ON PROJECT? If YES, attach explanation on starting work'without permit, includes dates. 8. WILL PROJECT UTILIZE STATE LAND?
❑Yes E&o Show work on map and/or drawings. El Yes 25No
9i PROPOSED USE: 2�Privaie 10. PROPOSED STARTING DATE: 1.1. APPROXIMATE COMPLETION DATE: 12. FEE OF(NYS Permit Only)
i
❑ Public ❑ Commercial g Enclosed
13. PROJECT 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 pro poied,water sources;extent of distribution system;etc.)
IE-Y1 X�S'i�•� � 5��{�' •M �fl/n!`'1<< n C,- _`2Ef"T •73Lvc_r- Conl3-1 Zti
N L t.-� 'T L -A cU%1= C13 LA L.<,H tt:-AD y C3 u.A ctri 5i.I.JXD , "Lc 1,-L w T A r5P-w k Zoo`
)`z1 °S� 7 ,a^�, �N'� -^z 5 mod_ •�-� �.���:: ,� r7 ii `n 15'T1u6- L-V'4ti- AJ
A Li- •-p C=�r°-i L_L Lz c,g- ''S 13�15 C. e'�.+_T.,
14. WILL THIS PROJECf REQUIRE ADDITIONAL FEDERAL, STATE ANDIOR Lei':%,L,PERMITS? ❑ Yes ❑ No If yes, please list:
1.5. 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 Soction 210.45 of the Penal Law
Further, tho applicant accvpts fill responsibility for all damage, direct or indirect, of N%-hatever,natth? �'��t"����tomever suffered, arming out of the project
described herein and agrees to indpnniifv and save harmless the State from suits, actions, damages an�o�s Utr�oEry name and description resulting from said
project In addition, Federal I-m. 18 U S.C. Section 1001 provides for a fine of not more than $10,000 or imprisonment for no( more than five years, or bosh.
whore an applicant knowingly and%0111011y talsifics,conceals, or coverS up a material fact;or knowingly makes or uses it false, tictitious or fraudulent state-ent
❑I hereby authoriir• the agent named in Number 4. above to submit this application on my behalf.
All ^ ?.fir�TUgl / IIIII
PLEASE READ ALL INSTRUCTIONS ON REVERSE SIDE
14 16-2 (2/87)--7c
617.21 SEQ 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 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 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 given project and its site. By identifying basic project
data, it assists a reviewer in the analysis that takes place in Parts 2 and 3.
Part 2: Focuses on identifying the range of possible 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 3 if appropriate), and any other supporting
information, and considering both the magitude and importance of each impact, it is reasonably determined by the
lead agency that:
❑ A. The project will not result in any large and important impact(s) and, therefore, is one which will not
have a Mgnificant 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 more large and important impacts that may have a significant impact
on the environment, therefore a positive declaration will be prepared.
* A Conditioned Negative Declaration is only valid for Unlisted Actions
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)
D ate
1
._'RT 1—PROJECT INFORMATIO__
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)
,Z C s"-f aA ySyt4 Cr_ R 0.4 D N
NAME OF APPLICANT/SPONSOR BUSINESS TELEPHONE
"41 ,4 J N�� (4 11) svg 9 46700
ADDRESS
(� o G<=ac>r /4✓G=
CITY/PO STATE ZIP CODE
4 Y lu6Aooi< 1. L AJY !/S63
NAME OF OWNER(If different) BUSINESS TELEPHONE
A Al C ( )
ADDRESS
CITY/PO STATE ZIP CODE
DESCRIPTION OF ACTION
70 /t<=PC,qc<= STblzm J��a�rAc�.s7 wqt(� NFU, LJjorj To B-ort— Tb
S%Rorvc�2 S i/}wJt�¢�2,�S w ik� 5 i X r-ooT �XT�,✓S<a,�/ jo .21,¢Tc N ��l c�<<.�r�
Please Complete Each Question—Indicate N.A. if not applicable
A. Site Description
Physical setting of overall project, both developed and undeveloped areas.
1. Present land use: ❑Urban ❑Industrial ❑Commercial ;.Residential (suburban) ❑Rural (non-farm)
❑Forest ❑Agriculture ❑Other
2. Total acreage of project area: acres.
APPROXIMATE ACREAGE PRESENTLY AFTER COMPLETION
Meadow or Brushland (Non-agricultural) acres 4114 acres
Forested acres acres
Agricultural (Includes orchards, cropland,_pasture, etc.) acres acres
Wetland (Freshwater or tidal as per Articles 24, 25 of ECL) acres acres
Water Surface Area acres acres
Unvegetated (Rock, earth or fill) acres acres
Roads, buildings and other paved surfaces acres acres
Other (Indicate type) acres acres
3. What is predominant soil type(s) on project site? C.4.4'y— 5.4.�s7
a. Soil drainage: ❑Well drained 2--1;- % of site ❑Moderately well drained So % of site
❑Poorly drained AS % 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? 1✓ ✓¢ acres. (See 1 NYCRR 370).
4. Are there bedrock outcroppings on project site? ❑Yes XNo
a. What is depth to bedrock? (in feet)
2
> Co
5. Approximate percentage of proposed project site with slopes: ❑0-10% V % ❑l0-15% %
Ell 5% 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 KNo
7. Is project substantially contiguous to a site listed on the Register of National Natural Landmarks? ❑Yes ❑No
8. What is the depth of the water table? feet)
9. Is site located over a primary, principal, or sole source aquifer? ❑Yes NNo
10. Do hunting, fishing or shell fishing opportunities presently exist in the project area? ❑Yes 1ANo
11. Does project site contain any species of plant or animal life that is identified as threatened or endangered?
[]Yes KNo 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 neighborhood as an open space or recreation area?
❑Yes KNo If x'/ explain
Nc>
14. Does the present site include scenic views known to'be important to the community?
❑Yes �4No
15. Streams within or contiguous to project area: � —
a. Name of Stream and name of River to which it is tributary
16. Lakes, ponds, wetland areas within or contiguous to project area:
a. Name A) b. Size (In acres)
17. Is the site served by existing public utilities? �, Dyes 1!gNo -
a) If Yes, does sufficient capacity exist to allow connection? ❑Yes ❑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 'gNo
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? []Yes 1KNo
20. Has the site ever been used for the disposal of solid or hazardous wastes? ❑Yes ;kg No
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'' 11.3 acres.
b. Project acreage to be developed: acres initially; N A acres ultimately.
c. Project acreage to remain undeveloped acres.
d. Length of project, in miles: So tS c'i(If appropriate)
e. If the project is an expansion, indicate percent of expansion proposed ^J A %;
f. Number of off-street parking spaces existing AJ/09 proposed _.
g. Maximum vehicular trips generated per hour t� 1A (upon completion of project)?
h. If residential: Number and type of housing units:
One Family Two Family Multiple Family Condominium
Initially
Ultimately _
i. Dimensions (in feet) of largest proposed structure height; 8&—%!A width; So Fr' length.
j. Linear feet of frontage along a public thoroughfare project will occupy is? Ljl ft.
3
2. How much natural material (i.e., roc'K,-earth, etc.) will be removed from the sitKwu AIoAJ4J tons/cubic yards
3. Will disturbed areas be reclaimed? ❑Yes ❑No YN/A
a. If yes, for what intended purpose is the site being reclaimed?
b. Will topsoil be stockpiled for reclamation? ❑Yes -,CNo
c. Will upper subsoil be stockpiled for reclamation? ❑Yes ZNo
4. How many acres of vegetation (trees, shrubs, ground covers) will be removed from site? a1OAI acres.
5. Will any mature forest (over 100 years old) or other locally-important vegetation be removed by this project?
❑Yes '&No
6. If single phase project: Anticipated period of construction z months, (including demolition).
7. If multi-phased: A/4
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 ❑No
8. Will blasting occur during construction? ❑Yes 'KNo
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 )PNo If yes, explain
12. Is surface liquid waste disposal involved? ❑Yes NNo
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? ❑Yes 1I,No Type
14. Will surface area of an existing water body increase or decrease by proposal? ❑Yes ;1No
Explain
15. Is project or any portion of project located in a 100 year flood plain? ?'§Yes ❑No
16. Will the project generate solid waste? ❑Yes `gNo
a. If yes, what is the amount per month tons
b. If yes, will an existing solid waste facility be used? ❑Yes ❑No
c. If yes, give name., location
d. Will any wastes not go into a sewage disposal system or into a sanitary landfill? ❑Yes ❑No
e. If Yes, explain
17. Will the project involve the disposal of solid waste? ❑Yes %No
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? ❑Yes XINo
19. Will project routinely produce odors (more than one hour per day)? ❑Yes AN
20. Will project produce operating noise exceeding the local ambient noise levels? ❑Yes ❑No
21. Will project result in an increase in energy use? ❑Yes VNo
If yes , indicate type(s)
22. If water supply is from wells, indicate pumping capacity -� gallons/minute.
23. Total anticipated water usage per day --�T�'� gallons/day.
24. Does project involve Local, State or Federal funding? ❑Yes KNo
If Yes, explain
4
25. Approvals Required: Submittal
Type Date
City, Town, Villaga Board ❑Yes o
City, Town, Village Planning Board ❑Yes No
City, Town Zoning Board []Yes No
City, County Health Department ❑Yes No
Other Local Agencies ❑Yes No
Other Regional Agencies ❑Yes No
State Agencies ❑Yes No
Federal Agencies ❑Yes No
C. Zoning and Planning Information
1 . Does proposed action involve a planning or zoning decision? ❑Yes $4No
'If Yes, indicate decision required:
❑zoning amendment ❑zoning variance ❑special use permit ❑subdivision ❑site plan
❑new/revision of master plan ❑resource management plan ❑other
2. What is the zoning classification(s)of the site? R� /��n�?i�I t-
3. What is the maximum potential development of the site if developed as permitted by the present zoning?
�J 4
4. What is the proposed zoning of the site? �S�Slr��r✓T/A
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? ) Yes ❑No
7. What are the predominant land use(s) and zoning classifications within a '/ mile radius of proposed action?
Re5.":Dr'r;y714 L
8. Is the proposed action compatible with adjoining/surrounding land uses within a 1/< mile? 9Yes ❑No
9. If the proposed action is the subdivision of land, how many lots are proposed? .JZtg
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 XNo
11 . Will the proposed action create a demand for any community provided services (recreation, education, police,
fire protection)? ❑Yes XNo
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 XNo
a. If yes, is the existing road network adequate to handle the additional traffic? ❑Yes El No
D. Informational Details
Attach any additional information as may be needed to clarify your project. If there are or may be any adverse
impacts associated with your proposal, please discuss such impacts and the measures which you propose to mitigate or
avoid them.
E. Verification
I certify that the information provided above is true to the best of my knowledge.
Applicant/Sponsor Name �Sn I c 4 4 LJ VA-(f}✓ ^Jt. ►Z_ Date
Signature l cV `�I Title d -�-
If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form"befpre proceeding
with this assessment.
5
Part 2-13I._JJECT IMPACTS AND THEIR Mfi, "IITUDE
Responsibility of Lead Agency
General Information (Read Carefully)
o 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.
a identifying that an impact will be potentially large (column 2) does not mean that it is also necessarily significant.
Any large impact must be evaluated in PART 3 to determine significance. Identifying an impact in column 2 simply
asks that it,be looked at further.
a 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.
a The number of examples per question does not indicate the importance of each question.
e In identifying impacts, consider long term, short term and cumlative effects.
Instructions (Read carefully)
a. Answer each of the 19 questions in PART 2. Answer Yes if there will be any 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. If reviewer has doubt about size of the impact then consider the impact as potentially large and proceed to PART 3.
e. If a potentially large impact checked in column 2 can be mitigated by change(s) in the project to a small to moderate
impact, also check the Yes box in column 3. A No response indicates that such a reduction is not possible. This
must be explained in Part 3.
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 project site?
❑NO ❑YES
Examples that would apply to column 2
® Any construction on slopes of 15% or greater, (15 foot rise per 100 ❑ ❑ ❑Yes []No
foot of length), or where the general slopes in the project area exceed
10%.
e Construction on land where the depth to the water table is less than ❑ ❑ El Yes ❑No
3 feet.
• Construction of paved parking area for 1,000 or more vehicles. ❑ ❑ El Yes El No
o Construction on land whL're bedrock is exposed or generally within ❑ ❑ ❑Yes ❑No
3 feet of existing ground surface.
o Construction that will continue for more than 1 year or involve more ❑ ❑ El Yes ❑No
than one phase or stage.
e Excavation for mining purposes that would remove more than 1,000 ❑ ❑ ❑Yes ❑No
tons of natural material (i.e., rock or soil) per year.
• Construction or expansion of a sanitary landfill. ❑ ❑ ❑Yes ❑No
o Construction in a designated floodway. ❑ ❑ ❑Yes ❑No
• Other impacts ❑ ❑ ❑Yes El No
2. Will-there be an effect to any unique or unusual land forms found on
the site? (i.e., cliffs, dunes, geological formations, etc.)❑NO ❑YES
• Specific land forms: ❑ ❑ ❑Yes ❑No
6
1 2 3
IMPACT ON WATER Small to Potential Can Impact Be
3. Will proposed action affect any water body designated as protected? Moderate Large Mitigated By
Impact Impact Project Change
(Under Articles 15,24, 25 of the Environmental Conservation Law, ECL)
LINO 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. ❑ ❑ El Yes []No
• Construction in a designated freshwater or tidal wetland. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ El Yes ❑No
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. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ ❑Yes ❑No
5. Will Proposed Action affect surface or groundwater
quality or quantity? ONO DYES
Examples that would apply to column 2
• Proposed Action will require a discharge permit. ❑ ❑ El Yes El No
• Proposed Action requires use of a source of water that does not ❑ ❑ El Yes []No
have approval to serve proposed (project) action.
• Proposed Action requires water supply from wells with greater than 45 ❑ ❑ ❑Yes El No
gallons per minute pumping capacity.
• Construction or operation causing any contamination of a water ❑ ❑ El Yes ❑No
supply system.
• Proposed Action will adversely affect groundwater. ❑ ❑ El Yes ❑No
• Liquid effluent will be conveyed off the site to facilities which presently ❑ ❑ El Yes ❑No
do not exist or have inadequate capacity.
• Proposed Action would use water in excess of 20,000 gallons per ❑ ❑ ❑Yes ❑No
d ay.
• Proposed Action will likely cause siltation or other discharge into an ❑ ❑ El Yes El 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 ❑ ❑ ❑Yes ❑No
and/or sewer services.
• Proposed Action locates commercial and/or industrial uses which may ❑ ❑ El Yes ❑No
require new or expansion of existing waste treatment and/or storage
facilities.
• Other impacts: ❑ ❑ ❑Yes ❑No
6. Will -proposed action alter drainage flow or patterns, or surface
water runoff? ONO OYES
Examples that would apply to column 2
• Proposed Action would change flood water flows. ❑ ❑ ❑Yes ❑No
7
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated By
Impact Impact Project Change
• Proposed Action may cause substantial erosion. ❑ ❑ ❑Yes ❑No
• Proposed Action is incompatible with existing drainage patterns. ❑ ❑ El Yes ❑No
• Proposed Action will allow development in a designated floodway. ❑ ❑ ❑Yes El No
• Other impacts: ❑ ❑ El Yes ❑No
IMPACT ON AIR
7. Will proposed action affect air quality? ❑NO ❑YES
Examples that would apply to column 2
• Proposed Action will induce 1,000 or more vehicle trips in any given ❑ ❑ El Yes El 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 El No
heat source producing more than 10 million BTU's per hour.
• Proposed action will allow an increase in the amount of land committed ❑ ❑ El Yes ❑No
to industrial use.
• Proposed action will allow an increase in the density of industrial ❑ ❑ El Yes ❑No
development within existing industrial areas.
• Other impacts: ❑ ❑ ❑Yes El No
IMPACT ON PLANTS AND ANIMALS
8. Will Proposed Action affect any threatened or endangered
species? ❑NO ❑YES
Examples that would apply to column 2
• Reduction of one or more species listed on the New York or Federal ❑ ❑ ❑Yes El No
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 ❑No
• Application of pesticide or herbicide more than twice a year, other ❑ ❑ El Yes El No
than for agricultural purposes. i
• Other impacts: ❑ ❑ ❑Yes ❑No
• i
9. Will Proposed Action substantially affect non-threatened or
non-endangered species? ❑NO ❑YES
Examples that would apply to column 2
• Proposed Action would substantially interfere with any resident or ❑ ❑ El Yes El No
migratory fish, shellfish or wildlife species.
• Proposed Action requires the removal of more than 10 acres ❑ ❑ ❑Yes El No
of mature forest (over 100 years of age) or other locally important
vegetation.
IMPACT ON AGRICULTURAL LAND RESOURCES
10. Will the Proposed Action affect agricultural land resources?
❑NO ❑YES
Examples that would apply to column 2
• The proposed action would sever, cross or limit access to agricultural ❑ ❑ ❑Yes ❑No
land (includes cropland, hayfields, pasture, vineyard, orchard, etc.)
8
1 2 3
Small to Potential Can Impact Be
Moderate Large Mitigated By
Impact Impact Project Change
• Construction activity would excavate or compact the soil profile of ❑ ❑ El Yes ❑No
agricultural land.
• The proposed action would irreversibly convert more than 10 acres ❑ ❑ ❑Yes ❑No
of agricultural land or, if located in an Agricultutal.District, more
than 2.5 acres of agricultural land.
o The proposed action would disrupt or prevent installation of agricultural ❑ ❑ ❑Yes ❑No
land management systems (e.g., subsurface drain lines,,outlet ditches,
strip cropping); or create a need for such measures (e.g. cause a farm
field to drain poorly due to increased runoff)
• Other impacts: ❑ ❑ El Yes El No
IMPACT ON AESTHETIC RESOURCES
11 . Will proposed action affect aesthetic resources? ❑NO ❑YES
(If necessary, use the Visual EAF Addendum in Section 617.21,
Appendix B.)
Examples that would apply to column 2
• Proposed land uses, or project components obviously different from ❑ ❑ ❑Yes El No
or in sharp contrast to current surrounding land use patterns, whether
man-made or natural.
• Proposed land uses, or project components visible to users of ❑ ❑ El Yes El No
aesthetic resources which will eliminate or significantly reduce their
enjoyment of the aesthetic qualities of that resource.
• Project components that will result in the elimination or significant ❑ ❑ ❑Yes ❑No
screening of scenic views known to be important to the area.
• Other impacts: ❑ ❑ ❑Yes El No
IMPACT ON HISTORIC AND ARCHAEOLOGICAL RESOURCES
12. Will Proposed Action impact any site or structure of historic, pre-
historic or paleontological importance? ❑NO ❑YES
Examples that would apply to column 2
• Proposed Action occurring wholly or partially within or substantially ❑ ❑ ❑Yes ❑No
contiguous to any facility or site listed on the State or National Register
of historic places.
• Any impact to an archaeological site or fossil bed located within the ❑ ❑ ❑Yes ❑No
project site.
• Proposed Action will occur in an area designated as sensitive for ❑ ❑ ❑Yes ❑No
archaeological sites on the NYS Site Inventory.
• Other impacts: ❑ ❑ ❑Yes ❑No
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 ❑NO ❑YES
• The permanent foreclosure of a future recreational opportunity. ❑ ❑ ❑Yes ❑No
• A major reduction of an open space important to the community. ❑ ❑ El Yes ❑No
• Other impacts: ❑ ❑ ❑Yes El No
9
1 2 3
IMPACT ON TRANSPORTATION Small to Potential Can Impact Be
14. Will there be an effect to existing transportation systems? Moderate Large Mitigated By
❑NO ❑YES Impact Impact Project Change
Examples that would apply to column 2
• Alteration of present patterns of movement of people and/or goods. ❑ ❑ El Yes ❑No
Proposed Action will result in major traffic problems. ❑ ❑ El Yes ❑No
• Other impacts: ❑ ❑ El Yes ❑No
IMPACT ON ENERGY
15. Will proposed action affect the community's sources of fuel or
energy supply? ❑NO ❑YES
Examples that would apply to column 2
a Proposed Action will cause a greater than 5% increase in the use of ❑ ❑ ❑Yes El No
any form of energy in the municipality.
• Proposed Action will require the creation or extension of an energy ❑ ❑ El 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.
• Other impacts: ❑ ❑ ❑Yes ❑No
NOISE AND ODOR IMPACTS
16. Will there be objectionable odors, noise, or vibration as a result
of the Proposed Action? ❑NO ❑YES
Examples that would apply to column 2
• Blasting within 1,500 feet of a hospital, school or other sensitive ❑ ❑ El Yes ❑No
facility.
• Odors will occur routinely (more than one hour per day). ❑ ❑ ❑Yes ❑No
• Proposed Action will produce operating noise exceeding the local ❑ ❑ El Yes El No
ambient noise levels for noise outside of structures.
i
• Proposed Action will remove natural barriers that would act as a ❑ ❑ ❑Yes ❑No
noise screen.
• Other impacts: ❑ ❑ ❑Yes ❑No
IMPACT ON PUBLIC HEALTH .
17. Will Proposed Action affect public health and safety?
❑NO ❑YES
Examples that would apply to column 2
• Proposed Action may cause a risk of explosion or release of hazardous ❑ ❑ El Yes ❑No
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.
• Proposed Action may result in the burial of "hazardous wastes" in any ❑ ❑ ❑Yes ❑No "
form (i.e. toxic, poisonous, highly reactive, radioactive, irritating,
infectious, etc.)
• Storage facilities for one million or more gallons of liquified natural ❑ ❑ ❑Yes ❑No
gas or other flammable liquids.
• Proposed action may result in the excavation or other disturbance ❑ ❑ ❑Yes El NO
within 2,000 feet of a site used for the disposal of solid or hazardous
waste.
• Other impacts: ❑ ❑ ❑Yes El No
10
IMPACT ON GROWTH AND CHARACTER 1 2 3
Small to Potential Can Impact Be
OF COMMUNITY OR NEIGHBORHOOD Moderate Large Mitigated By
18. Will proposed action affect the character of the existing community? Impact Impact Project Change
ONO DYES
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%.,
• The municipal budget for capital expenditures or operating services ❑ ❑ El Yes El No
will increase by more than 5%" per year as a result of this project.
• Proposed action will conflict with officially adopted plans or goals. ❑ ❑ ❑Yes El No
• Proposed action will cause a change in the density of land use. ❑ ❑ El Yes ❑No
• Proposed Action will replace or eliminate existing facilities, structures ❑ ❑ El Yes ❑No
9
or areas of historic importance to the community.
• Development will create a demand for additional community services ❑ ❑ El Yes ONo
(e.g. schools, police and fire, etc.)
• Proposed Action will set an.important-precedent for future projects. ❑. ❑ El Yes El No
• Proposed Action will create or eliminate employment. ❑ ❑ ❑Yes ❑No
• Other impacts: ❑ ❑ []Yes ❑No
19. 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 Identified as a Potential Large Impact or
If You Cannot Determine the Magnitude of Impact, Proceed to Part 3
Part 3—EVALUATION OF THE IMPORTANCE OF IMPACTS .
Responsibility of Lead Agency
Part 3 must be prepared if one or more impact(s) is considered to be potentially large, even if the impact(s) may be
mitigated.
Instructions
Discuss the following for each impact identified in Column.2 of Part 2:
.1 . Briefly describe the impact.
2. Describe(if applicable)how the impact could be mitigated or reduced to a small to moderate impact by project change(s).
3. Based on the information available, decide if it is reasonable to conclude that this impact is important.
To answer the question of 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)
11
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