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HomeMy WebLinkAboutTR-4344Board Of $outhold Town Trustees S.OUTHOLD, NEW YORK PERMIT NO 4.3.~ ............... DATE: .0/_30/':)~ .............. ISSUED TO .....~ILLIAM..TU.ITE .................... ............................................................. Pursuant to the provisions of Chapter 615 of the Laws of 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 REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on 19..9.~-.., and in consideration of the sum of $..100..00 ....... paid by o$ ........ ~g.~.~!g. ......................................................... N. Y. and Terms and Condlfions listed on the reverse slde hereof, of Sou+hold Town Trustees authorizes and permits the following: G~=dE~e~ ~e~m[~ Eo~ ~ ~00~ b~]~e~d ~=d ~o~. ~0 w~ s~ht~o~ ~ ~e~ ~ov~de ~ ~0~ ~o~-~E all in accordance wifh the detailed specifications as pre~nfed in the originating application. IN WITNESS WHEREOF, The sai&Board of Trustees h~ere- by causes ifs Corporate Seal fo be affixed, and these presents be subscribed by a majority of the said Board as of this daf, e. ................. ....... Trustees HENRY P. SMITH, President JOHN M. BREDEMEYER, Vice-Pres. PHILLIP J. GOUBEAUD ALBERT KRUPSKI, JR. ELLEN M. LARSEN BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 November 4, 1987 TELEPHONE f516) 765-1892 Mr. William E. Tuite 1777 Harvard Avenue Merrick, NY 11566 Re: 580 Midway Road, Southold, NY 11971 Dear Mr. Tuite: The followink action was taken by the Board of Town Trustees during their regular meeting held on October 29, 1987 regarding the above matter. Moved by Trustee Krupski seconded by Trustee Larsen WHEREAS, William E. Tuite requested a Waiver of the Wetland Ordinance for the extension of a porch (25'x 7') in conjunction with other major repairs to the dwelling located at 580 Midway Road, Southold WHEREAS, the Board members have personally viewed and are familiar with the property in question and the surrounding area, and WHEREAS, the Board made the following findings of fact: 1. By this request appellant requests permission to extend a porch in conjuntion to other major repairs on his dwelling. 2. The project will not affect the health, safety and general welfare of the people of the town. 3. There has been no response from the Conservation Advisory Council so it is assumed there are no objections to the project. Now Therefore be it RESOLVED that William E. Tuite be and hereby is granted a Waiver of the Wetland Ordinance as requested to extend 'a porch (25~ x 7') in conjunction with other major repairs to the dwelling located at 580 Midway Road, Southold. Vote of Board: Ayes: All - This resolution was declared duly adopted. Very truly yours, H?n~r~ith ,~' p~ Board. of Town Trustees HPS :ip cc: Bldg. Dept. C.~.C. Board of Appeals .Albeit A Krupski, President John Hohapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 Office Use Only: Coastal Erosion Permit Application Coastal Erosion Variance Application Wetland Permit Application Waiver from Chapter 97(Application/ --Trustee Lands Permit Application ~Grandfather Permit Application Completed Apps. Date: ~Inspection date: ~-%~. ~CAC comments-Date: Sent~ec. Variance Required: (Y/N~ ''~ Neighbors notified-Date: SEQRA Type Coord.: Date sent 'SEQRADetermin./date: Public Hearing/date: Findings: Approved (Y/N) Special Conditions: (Y/N) (see file) Permit(s) issued-date: Application DATe. REC.: Number;SCTM%1000- ¢~'f & Date_~_~_ Interest: (owner, consultant,lessee,etc. ) Owner of Property: A IJ//¢~4 f- ~ P/)-zg/~/? Address ~O ~i~0~/ Subject Property Location: /ooo oqo (Provide LILCO Pole %, Distance to location map) cross Streets if not on THIS IS NOT A PERMIT Manner in which material will be removed or deposited: Width of canal, creek or ~ fronting property: Depth at low tide: 6~ Aver. rise in tide: Distance to nearest channel: Distance project extends beyond similar projects in area: Area zoning: ;<k~/~J~/~& Land area in acres: Is project for private or business use: F~/V~7~ Tr~~ use of property: ~o/~ 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 Governmental Agency: Project Description The project description must also include plans for reclamation of land disturbed during construction of the principle and accessor~ structures and underground structures (i.e., pipeline and septic system; make additional attachments if necessary). THIS IS NOT A PERMIT ,14.16-4 (:2J87)--Text 12 'J PROJECT LD. NUMBER SEQF, 617.21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only =ART i--PROJECT INFORMATION (To be completed by Applicant or Project sp'bnsor) I 2. PROJECT NAME I..APPLICANT/SPONSOR /~..~ ~ 7~.~ 3. PROJECT LOCATION: -- ~ ~ .7.~.~z~ ~_~ County Mun,clpal,ty ~'//~ ~ ~ 4. PRECISE LOCATION (Street address and load intersections, prominent landmarks, etc.. o~ provide map) 5. IS PROPOSED ACTION: [] New [] Expansion *~ Modificatlonlalteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: -.. ~ Initially ,E~ acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] No If No, describe briefly 9. WHAT tS PRESENT LAND USE IN VICINITY OF PROJECT? ~Residential [] !ndustrial [] Commercial Describe: [] Agriculture [] Park/Forest/Open soace [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? ,~Yes [] No If yes, list agency(s) and permit/approvals 11. DOES ANY ASPECT OF THE ACTIOH HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes ~o If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? r-~ Yes ~No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ~pplicantlsp~ r n m' _ ~ /' ' ~ f-1 ~ ~ ' , ' If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessmen~ Form before proceeding with this a~,s, essment OVER A, .DOES AC.,TION E.~,%C, EED ANY TYPE I THR~:~HOLD IN 6 NYCRR. PART 617.'t27 It yes` coo~na~ the r~ ~e~ ~ Wl~ A~ON REC~IVE COORDINATED R~ID AS PROVIDED FOR UNuSTED ACTIONS IN 6 NYCRR, PART 617.57 m~y be sugetsede~by ~ol~e~ involv~ agent. C. COULD ACT]ON RESULT IN ANY ADVERSE EFFECTS ,~,SSQC[ATED WITH THE FOLLOWING.' (Answers may be INandwrltten, il Cl, Existing air quality, surface or groundwater quality or quantity, noise levelS, ex,sting tralftc patterns, sottd waste Procluctlon or potential for erosion, drainage or Ilooding Problems? Exiaiain 13flatly:. ' : C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or Community or neigl~borhood oh. erector? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife slaecies, significant habitats, or threatened'or endangered s0ecies? Explain brle~t7: C4. A community's existing plans or goals as olftcially adopted, or a change in use or Intensity of use of land or. other natural resources? Explal~ briefly: Growth. subsequent c[evelopment, or ~elatea activities likely to be induced by the Droposecl action? Extalal~ 0r~'etty. ~'-. :-..= ........ CS. Long term, short term, cumutative, or other effects not identified in C1,C57 Exiolain briefly. C7. 0thor impacts (inclUding changes in. use of either quantity Or type of ene(gy)? Explain briefly. O. l~ THERE. OR IS THERE LIKELY TO GE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL hMPACTS? H' Yes. explain briefly PART III--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIO~'~S: 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. urb=n or rurat); (b) probability of occurring; (c) duration; (d) i~r6vers~0ility; (e) geographic scope; and (0 magnitude. If necessary, add attachments or reference supporting materials. Eflsure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. [~] Chock this box if you have identified one or more Potentially large.or significant adverse impacts which MAY :' occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [] Check this box. if you have determined, based on the information and analysis above and ~any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts ANO provide on attachments as necessary, the reasons supporting this determination: BOARD OF TOWN TRUSTEES TOh~N OF SOUTHOLD · Town Hall, 53095 Main Road P.O. Box 728 Southold, New York 11971 TELEPHONE (516) 765-1892 APPLICATION IS HEREBY MADE TO THE TOWN TRUSTEES OF THE TOWN OF SOUTHOLD, SUFFOLK COUNTY, NEW YORK FOR THE ISSUANCE OF A PERMIT PURSUANT TO~ THE LAWSi ORDINANCES AND REGULATIONS GOVERNING THE COASTAL AND INTERIOR WETLANDS, FLOOD PLAINS AND DRAINAGE AREAS OF THE TOWN OF SOUTHOLD, AND THE ISSUANCE' OF PERMITS PURSUANT TO CHAPTER 32 OF THE CODES OF THE TOWN OF SOUTHOLD. DATE OF' APPLICATION PHONE NO APPL I CAT I ON NO. IDENTITY OF APPLICANT .IV/ .... AGENT__~_ ~ ~L~__~Z--~ LOCATION OF PROPERTY FOR WHICH PERMIT WANTED HOME ADDRESS OF PERMIT APPLICANT IF DIFFERENT FROM AFORESAID LOCATION CREEK, BAY OR HARBOR FRONTING PROPERTY W I DTH 7 HEIGHT ABOVE HIGH WATER YARDS TO BE EXCAVATED~..~_~_~_~._~_~__~__~-__~_~,~r'~ ~.._~.~ YARDS TO B~ FILLED ~ ~ ' N~ WIDTH O~ CANAL, C~EEK OR BAY FRONTIN~ P~OPERTY ~+ ~~ · OW. DISTANCE TO THE NEAREST CHANNEL FT, DISTANCE PROJECT EXTENDS BEYOND SIMILAR PROJECTS IN THE AR£A ' ~ ~ FT IS THIS FOR PRIVATE OR BUSINESS USE?-?~.~~' ~ ~~ ~,,.t~._~_~' AREA ZONING MANNER IN WHICH MATERIAL WILL BE REMOVED OR DEPOSITED ~'~~ O~ INyENDED USE OF PROPERTy DESCRIBE ANY KNOWN PRIOR OPERATIONS CONDUCTED ON THE PREMISE AND WHETHER ANY PRIOR LICENSE OR PERMITS HAVE BEEN IsSUED'TO :ERRECT STRUCTURES OR TO DREDGE*OR DEPOSIT FILL ON SAID PREMISES AND WHETHER ANY PERMITS OR LICENSES WERE EVER' SUSPENDED OR REVOKED BY A GOVERNMENTA! AGENCY 'DESCRIB'E 'FUI~.Ly THE REHABILITATION AND P~OPOSED CONDITION OF THE PREMISES AFTER THE ~ORK IS COMPLETED INCLUDE .AN ADDITIONAL SURVEY OF WRITTEN CONSENT OF THE'OWNER OF THE PROPERTY, IF NOT THE SALVE AS THE APPL! CANT. ARE THERE ANY COVENANTS OR RESTRICTIONS IN YOUR DEED THAT WOULD PROHIBIT ~HIS PROJECT? 14-t6-4 12J87)--Text 12 /PROJECT I.D. NUMBER '1 617.21 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 spbnsor) SEQF 1. APPLICANT/SPONSOR I 2. PROJECT NAME 3. PROJECT LOCATION: Munici ~ality ~D/~L County ~ ~' 1~ 4. PRECISE LOCATION (Street address and roaa intersections, prominent landmarks, etc., or provide map) 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: ,nitially )< 7 U timately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [~Residential [] Industrial [] Commercial Describe: [] Agriculture [] Park/Forest/Open space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY STATE OR LOCAL)? ~yes [] No If yes, list agency(s) and permit/approvals FEDERAL, 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [~No ~f yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: /'"~¢/~/_-4/ L ¢¢~ ' /t'~, '~'-'~/'.,.~-- Date: Signature:. _ {_/~' ~- ./~//~'4--"~?~ 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 PART II--ENVIRONMENTAL A~-'-~SSMENT (To be completed by Agency) A. DOES ACTION EXCEED ANY TYPE I'I-~RESHOLD IN 6 NYCRR, PART 617.12') If yes. coordinate the review process anc use the FU'LL []Yes []No . ,.,. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 8 NYCRR, PART 617.67 If No, a negatwe 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) C1. Existing air quality, surface or'groundwater quatity 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 wiJ dlife species, significant habitats, or threatened or endangered species? Ex plain briefly: 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 identifiee in C1-C57 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, CONTROVEt:SY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, e:~ plain briefly PART Ill--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 n connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (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 al relevant adverse impacts have been identified and adequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse impacts which occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: Print or [ype Name or Responsible Officer ~n Leac Agency Signature ol' Resl:)ons~ble Officer m Lead Agency Name of Lead Agency Date Title ot Responsible Officer Signature or Preparer (It ddferent from responsible officer) COUNTY OF SUFFOLK ) STATE OF NEW YORK )SS: BEING DULY SWORN DEPOSES AND SAYS THAT HE iS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS, AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS KNOWLEDGE AND BELIEF, THAT THE WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION A~D AS MAY BE APPROVED BY THE TOWN BOARD OF THE TOWN OF SOUTHOLD. 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, IF GRANTED. in completing this app!igatio~ I hereby authorize the Trusteesj agent or representative to enter onto my property to inspect the premises in conjunction with reviDw~of this application. SIGNATURE OF APPLICANT SWORN TO BEFORE ME THIS NOTA~PUBLIC ELIZABETH ANN NEVILLE Notary Public, State of New York No. 52-8125850, Suffolk Co~ T. rrn Expires October 3'! o 19~_.. EXAMINED APPROVED "WETLANDS" PERMIT (CHAPTER 97) APPROVED "BOAT,DOCKS, WHARVES" PERMIT (CHAPTER 32) DISAPPROVED "WETLANDS PERMIT" (CHAPTER 97) DISAPPROVED "BOATS,DOCKS, WHARVES" PERMIT (CHAPTER 32) CONDITIONS, IF ANY EXAMINING BODY SIGNATURE OF CHAIRMAN COMPUTATION OF FEES Approved 2/27/85 · . REF ONLY' 1000-090-02-006 do8 S'HO 4751 M ID WA Y / PR/II,~7£,) ROAD LOT I/3 .. _ F! /',/ri/ N 69:$0'-I0"W ' 98.70 LITTLE PECONIC 8AY 6'UR VEY OF' PROPERTY TOWN OF SUFFOLK COUNTY NEW YORK SCA LE : /"-' 2~" Pro£e$sl'onol Land 3urve~.tof 1~0 MFDFORO AVE. PATOHOOUE.~ N. Y. Phone 475--519~ D A T E,5 T 1281 ,SURVEYED" NOVEMGER 24, IgSl ; DEC /0, 19~1 Lo/nos. 6howrl hereon re/~:r Iv M~p 05 riO. 90. Pr~m/~S oi6o ~howfl a5 Lore ~rown qf 6~/lZ/~w, filed dan. g~ /52~ ~5 ~ 002. ~ / TUI TE TRUSTEES John M. Bredemeyer, III, President Albert J. Krupski, Jr., Vice President Henry P. Smith John B. Tuthilt William G. Albertson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 June 25, 1993 William Tuite 580 Midway Road Southold, NY 119971 RE: SCTM ~1000-90-2-6 Dear Mr. Tuite: After an onsite inspection was made on_the above reference property, the Board of Trustees decided that the proposed work is considered an ordinary repair. If we can be of further assistance,, please do not hesitate to contact this office. Very truly yours, John M. . Bredemeyer, President, Board of Trustees JMB:jmd TRUSTEES ~John M. Bredemeyer, III. President Albert J. Krupski, Jr., Vice President Henry P. Smith John B. Tuthill William G. Albenson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 I~ Office Use Only: ~_V~Coastal Erosion Permit ApPlication ~oastal Erosion Variance 'Application. ~/Wetland Permit Application ' ~ l%/Waiver from Chapter 97(Application/ .t.~rustee Lands Permit Application ~randfather Permit Application ~%-JCompleted Apps Date~ ~ · ~_Inspection date: ' · ~CAC comments-Date: Sent Rec. [~?~ariance Required: (Y/N) ' tAhNeighbors notif~ted-Date: '~ SEQRA Type ~ ""Doord.: Date ~ I-~SEQRA Determin./date~ i--~Public Hearing/date: Findings: Approved (Y/N) Special Conditions: (Y/N) (see file) Permit(s) issued-date: DATE REC.: Application Fee: Application Number; SCTM~ 1000- Applicant: Interest: (owner, consultant,lessee,etc. ) Owner of Property '~t///~ ~ Address ~--~c> ~! /~ tO/~>~ Subject Property Location: Phone 7 g-Z978 (Provide LILCO Pole location map.) #, Distance to cross Streets if not on THIS IS' NOT A PEP~IT Page 1 Yds. to be excavated: ° ~ ~ Yds. to be filled: ~ Manner in which material will be removed or deposited: Width of canal, creek or--property: Depth at low tide: - o - Aver. rise in tide: Distance to nearest channel: extends beyond similar projects in area: Area zoning: Land area in acres: Is project for private or business use: P~l~~ Intended use of property: ~ ~1 ~ /~-/~ Describe known prior operations conducted on premises: Distance project Has any prior license or permit been issued to erect structures, dredge, or deposit fill on said premises: ,~Y'~? ~ ~ D ~ Has any license or permit ever been revoked or suspended by a Governmental Agency: /~ 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). THIs IS NOT A PERMIT Page 2 County. of Suffolk ) State of New York ) · ' ~f// ~ ' ' BEING DULY SWORN DEPOSES AND AFFIRMS T~AT 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. SWORN TO BEFORE ME THIS JOYCE M. WILl(INS Notary Public, State of New Yo~ No. 4952246, SuffOIkCourg¥ _ Term Expires June 12, SI~ATURE~-- ./ DAY OF ,19 Suggested space for location Map THIS IS NOT A PERMIT 1,",-'[6-4 t2187~--Text 12 [' PRS-JECr I.D. ~UMBE'a 61 , Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM SEQF For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be completed by ADDIiCant or Project sl~onsor) 1. APPLICANT/SPONSOR p,,~.. ~ i 2, PROJEC.). NAME 3. PROJECT LOCATION: 4. PRECISE LOCATION (Street address and roacl fntersect~ons, prominent landmarks, e~c., or provide map) 5. IS PROPOSED ACTION: [] New [] E×Danslon 6. DESCRIBE PROJECT BRIEFLY: [~ Modification/alteration Initially acres Ultimately acres ~ e. ~ ~)~-.~ - 8. W~,.PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? (2;:~Yes [] No If No describe briefly [] Park/ForestlO~en space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING,.NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL,'7'--- STATE OR LOCAL)? If ye~, list agency(si and permit/approvals 11. DOES ANY ASPECT OF THE ACTIOt,t HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] ~es ~.'o If yes, list agency name and permit/approval 12. AS A RESULT .OF P~OPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? r-]yes __,~O I CEF~TIFY THAT 'tHE INFORM/~AT/tO-~ROVIOED ABOVE IS TRUE TO THE BEST OF MY ~NOWLEDGE . Signature: 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 A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR. PARr 617.127 Il yea -~'~rdinate tr~e rewew proces~ EnO uso Irf, a F. ULL ~."'-~-'~"-~ [~] Yes [] No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PARr 617.67 I! No, a n~gatJve qeclarauon may be SUperseded by another involvec agency. C. COULD ACTION RESULT IN ANy ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may oe nanclwr~tten, if teq~ble) Cl. Existing air quality, surface or groundwater quality or quantity, noise levels, ex,sting tratHc patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeologJcal, historic, or other natural or cultural resources; or COmmumty or neighborhood characfer? Expl`aln brl,efly. C3. Vegetation or fauna, fish, shellfish or wildlife s!~ecies, significant habitats, or threateneq or endangered species? Explain briefly: C4. A community's e~isting plans or goals as offl,cially adopted, o~ a Change in use or Intensity of use of land or other natural resources? Explain briefly C5. Growth, subsequent development, or related activities hkely re be reduced by the Proposed action? Exotatn briefly. CS. Long lerm, snort term, cumulative, or other el,facts not identitied in CI-C57 Explain briefly. C7. Olher impacts (incl~ding Changes in use of either quantity or type of ehergy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENT AL ADVERSE ENVIRONMENTAL IMPACTS? [~] Yes [] NO If Yes, explain briel,ly PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For eacr~ adverse effect identified above, determine Whether it is substantial, large, important or Otherwise significant. Each elfect should be assessed in connection with its .(a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irrevers D ity; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanahons contain sufficient detail to show that all relevant adverse impacts have been identilied And adequately addressed. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL~EAF and/or prepare a Positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the 'proposed action .WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons suPporting this determination: TRUSTEES ~J0hn M. Bredemeyer, III, President Albert J. Krupski, Jr., Vice President Henry E Smith John B. Tuthill William G. Albertson Telephone (516) 765-1892 Fax (516) 765-1823 SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road .~. :~'~ EO. Box 1179 ~~ Southold, New York 11971 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 year Maintenance Agreement Erosion Protection Structures Chapter 37 Southold Town-Code South°ld Trustees as Administrator type or print name(s) ~ (~ /~--~ the owners of record of property at: ~ ~t~oJ~Y ~ (type or prin~ street address) SCTM #1000- 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 of 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 sikuation'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 ~pon 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 SWORN TO BEFORE ME THIS DAY OF .,19 NOTARY PUBLIC Please submit three copies of a licensed land survey made within one year of the original construction. This maintenance agreement shall only be vali~ upon the final approval of the administrator. Subsequent owners may apply to the Southold Town Trustees to re-authorize this maintenance agreement. Town Ha! i 5;:!!;() 95 ?.'fa i n Rf::~a d F:', 0,, Box 1;1.79 ~::'"~ '~ ........ '" N Y,, :1.1971 t4:i.n'i:,er ~,'L~:~r'rns ci-F :1992-;i. 993,, :i: understand 'Lhat the nccLi.Ft.~;ec~ cfi: 'l:'."le waiver period,, Because c-F the vi.;,~r"y m:i. nor s:i. ze o,f: th;i. s t;:)rc)jec'E .... 'ius'i= to) ":,,",~ ...... ., f~.,.,h,L l;,l ll~;.:, pi, aC<{,:, 1 oclk 'T'h:i. s :i. s mc)re cfi: a ,,;: arden:i, n~.;.t project, than r'epa:i, r ~:;.~'" c:c;,nstruct ;i. on and ;i. t ;i, s .~ c;)~ .... l':h :i. s re,z.",.sor'i and 'Li"~.e s:i. :z. e o.F the t::;' r (::) .j (.:.:.:, c 'L ....... ~.. ~a~.. :i: request th:i. s wa:i. ver,, , REF ONLY' 1000'090'02'006 ,JO~ S'H'¢ 4751 M ID WA Y / PRII/47£) ._m,,,,,, $ 70: 45"$0"E . - 2..IS, 25 2~7'm4P ?esl LOT 115 LITTLE PECONIC BAY .Fcn; ~ 5UR' i/£Y OF PROPERTY 6/tuut~d at JlA FY1 E W TOWN OF $OUT/-/OLD 3UFFOLK COUNTY NEW YORK 56,4 LE: I''= 6 u r V,~r,~/ C dk t i £ / ¢ d t O' :;qYE 77 TLb- ,15;[?A RAIyTEE CO. ,ItVIL.Lt 4M TU,I'TE PAULA TUzTE :: I)AT£5 ~L/,RV£Y'£D '- h'Oi/£t4~ER 2_¢, 19~1 i 'r,'~ riM. ~;e ¢. DEC I0, 1951 120 MEDFORO AVE. pAT¢HOGUE~ N.~ Phone 47&--3t92 Lo/nos. 6hown hereon re/~¢r 1o Mep o£ Ceclar ¢eccch P~rif /f//ed 0ec. 20, 1927 T~I TE ~ ~ ~ 02. .