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PERMIT NO.
ISSUED TO
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O¡'.T(: . 7.f¿1I99
WlJ,LJ:\r: S, I: r-:I·[,Y i, ~;i\;inRA SIKORSKI
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Pursuant to the F·."':'·"~~S d Chc:'icr 615 of th~ Laws of
the State of New Yx~, '~77; ",1 C':.,:" Ie:" -104 (If the L.n·s of the
Sfate of New York 1957; ",wi th" ~"'Jtfdd Town Ordinance en-
titled "REGULATit<G þJ:D T! i" rV,C'·i':; C¡: orS-r~UCTIONS
IN AND ON TOV/¡~ V;'Aï ¡:RS :\: H.' f',.il;~ìC LI\:ms and the
REMOVAL Or: SAt·!D, G:lAVr:L Oft C"f!'!EP- ~.1ATFP.II.'"S FROM
LANDS UNDFR TOV/i·j \'¡r'.T':~::;" "i ¡" ,.:C'Or·:!1i1c'.! v"th the
Resolution of The 90¿Fd '--·~f~':"F:-o...J;:,1:) n;"~fi!;'; Ldd ('il 7/~~.IrJC~..
19 99, and in çon'idccati~n of tl", ",:n 'J;" ~ I "O.,eO p~id by
WiHiam S. Kdl{ t
of Soutlwlcl
Terms lIOd Con¿i:¡cr,;
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Albert J. Krupski, President
James I(ing, Vkl·f'n:sidelìt
Henry Smith
Artie Foster
Ken Poliwoda
) :~!¡
TO',"n lI,lll
iJ10nS I\!a:n TIoad
p .(1. fk'x 1179
Sl.kithold. r~P\"" YOi'k 11071
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T.....le-phane (516) 765·1892
Fax (G16) 765-1823
DOl\.flD (}C T(;~i."7·-l ,..{_~tùSTl~ES
'iOW~¡ OF SülTTHOLD
July 21, 199
William S. Kelly & Sandr~ Sikorski
P.O. Box 1680
Southold NY 11971
Re: SCTM #79-4-24
Dear Mr. Kelly & Ms. Slhcrski,
The following action was lakga hI ~h2 ß03J~ of Tawn Trustees
during a Regular Me8ting, 1:eld on ,hi__., .;I.'" IJ99, regarding the
above matter:
WHEREAS, WILLIA¡"¡ S. ¡æV,y & S;1;1:)[';, é; TY'JRS?;.r appLied to the
Southold Tm-m TrusteE:s [or a pCGIllt \.0:1<301: the provisions of the
Wetland Ordinance of the TOvm of Sopt.bold.. application dated
June 8, 1999 and,
WHEREAS, said applicaticn ~~s rcfer~cd to the Southold Town
Conservation Advisory CCI:;y;il .cOi: theé:: Undlngf3 and
recommendations, and
WHEREAS, a Public He¡n-L;¡g Wll': h·?ld. by the 'I'ovm Trustees with
respect to said application on July 21, 1999, at which time all
interested persons were given an o~0ortunity to be heard, and,
WHEREAS, the Board membe,-s have personRlly vie,,¡ed and are
familiar with the premis0-s jn (ì;Hj~:ti{'1''1 ¿~nd the surrounding area,
and,
WHEREAS, the Board ha3 cü;,~' i,'):' t"",·J ,.1.1 U", testiraony anc!
documentatlcn submi tted C(,!ì^;C, L'l) iDe ~.h:; ,,: a;',[-.1.i::ation, and,
WHEREAS, the structure cc:"\pJleo \'"L~-h th::-: stanùùrd set forth in
Chapter 97-18 of the f;outl1cld Tr.'l'n Co,.~;e,
WHEREAS, the Board has c!cteçmined t.héJt the project as proposed
will not affect tIle h8~lth, s~fety and gen~ral welfare of the
people of the town,
NOW THEREFORE BE IT,
~
.
.
RESOLVED, thaI: the BOÐYd ,.'< '1'1: 'c" ,) .. ,.'.,- ....,'. tJ~e "'-pplication of
WILLIAM S. KELLY & SU'\ìFi\ ~;;'..C;'..,:".i. ~"~ '_.j,l._:t.J ,":t a single f-::mily
dwelling with a trellis, w~ll, sal,lt~ry syst0m, and picket fence
in front yard, subject to rlÐcir,C! ¡,üy'c.'ale.'3 G·t the 35 foot
non-disturbance area durin.:J CC¡"¡:J,.cucti''=":1, as indicated on nevi
survey approved at the P1"~.~;_5.n¡J' f·C'(;at.E~d: IB':lO Brigantino Drive I
Southold.
BE IT FURTHER RESOLVED that t~is d~t0~~ination should net be
considered a determin2tio:1 rrxLJ for a,;y other Department or
Agency which may also h~ve an ~p~ljc~t'on pending for the same
or similar project.
Permit to con3truct a'",d c,~.'·pl,'t.·? "::,)J~c", yilL§..xpire two years
from the date it is signed. Fees Wll~:t be paid, if applicable,
and permit issued ,·¡ithin six mont_he; (,f the date cf this
notification.
Two inspections are req'l.i rc":i and l:~" 1'1."\'3 teas are to he noti f ied
upon completion of said project.
FEES: None
Very truly yours,
tla..e..-/ ª /&-,~ß¿ {?
Albert J. Krupski, J/. .
President, Board of Tru~le£a
AJK/djh
cc. DEC
Dept. of State
Heal th Dept.
.
.
Telephone
(516) 765,1801
Town Hal!, 53095 Main Road
P .0, Box 1179
Southold, New York 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting ofthe Southold Tov.m Conservation Advisory Council held Monday, July 19,
1999, the following recommendation was made:
Moved by Richard Smith, seconded by Ken Meskill, it was
RESOL VED to recommend to the Southold Town Board of Trustees APPROVAL WITH A
STIPULATION of the Wetland Permit Application of WILLIAM S. KELLY & SANDRA
SIKORSKI 79-4-24 to construct a single-family dwelling with a 1250 s.f footprint. Construct
trelace (open) attached to house, install private well, install on-site sanitary system, and install
picket fence in front yard.
1840 Brigantine Dr., Southold
The CAC recommends Approval as per the survey received in the Trustee's Office dated June 8,
1999, with the stipulation that haybales be placed along the construction site
Vote of Council: Ayes: All
Motion Carried
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Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P,O, Box 1179
Southold, New York 11971
Telephone (516) 765·18'12
Fax (516! 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use °
Œ ® Œ ~ W Œlr~1
JUN - 8 1999 !i:' , I
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T.OWN OF SOUTH:t-:;
1
"""', Jew - 8 1999
Name of Applicant-.JilrU TA.kA 5. 1/.s.11 t-I ¿ <~Di!A (Cn~
AddressYO. Rot I~~ ~.Jrl-V'r f"\ Nt.(
Coastal Erosion Permit Applicati
~etland Permit Application
___Grandfather Permit Application
Waiver/Amendment/Chan9~s
eceived Application: hl'JI'Itl
Received Fee:$/!'V ' _
_Completed Appli¡ation _ .
Incomplete_~~; ~(10"~
SEQRA Classificat:i/ðñ: () .
Type I_Type II..:&-unlisted_
Coordination:(date sent)
CAC Referral Sent: I:. - It - '1"-
Date of Inspection: 7-1«- 9 <;
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
Public Hearing Held: 7-rl/- f?
Resolution:
IÆO
C·
Phone Number: (
) 785 - 312:..-1
\\(\\ I)
Suffolk County Tax Map Number: 1000 - 1<1 - CY-i - Z4
Property Location:Jl.A~ L.rC:H'7S ¡;S-rIr1f:..,~ LDT -¡fS7
7Gb FT. J./ a: IE.
(provide LILCO Pole ,distance to cross streets, and location)
AGENT: NA
(If applicable)
Address:
AlA-
Phone:
FAX#:
I
Boan.:, ;"us;.~-: ,'"
. ·cct j,on
.
t¡Fl:ER!\.f-, Di\Tl\
Land Area (in square feet): _Hf:¿, 2..~.'1
Area Zoning: f..- L.j D
Previous use of property:~~~l-r
Intended use of property:,_6I"tJ(¿,Þ FÅI".!,J.LL/ OOf-/l.T,JÚ.
Prior permits/approvals for site improvements:
~
/
/'
Agency
)( No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a
governmental agency?
-Á-- No
Yes
If ye
rovide explanation:
--
--------------
pr~criPtion (use attachments
----
'f ~)
l' necessary:
CalSí{l L 'L-:T Sa,¡CU. r-l:Wý/ rJ QJJþ,L-TAY: 'iJVH-
iJ. /Z~ S,F. QDr W~
(c::NS-rIWL-r lPþ I Ni;:~í0Pf:¿))_ATI~ TD /-là)::f-
INSTALL Ye.LV4~V--Lf;;l,L
1lJS -rALL Ul-'fSìTL HJJr:r!l~t!f2"ú;,,^
.mSîALL FtrY¡::T F0J(r;;- 1~ F~T '-IAZ{)
2
Boarèe[ ',-_ ~ ~_~...~,I::~~· <.--; /.'....~-·r'.'. ..(::iLlcil .
WETLAND/TRUST¡;;~ IJ,NDS Þ.Pi'r~le;ŒION DA'~A
Purpose of the proposed op~ratio~s:__e!¿;;jL[¿F~~
Area of wetlands on lot: ~ Z?-(:{;:;
Percent coverage of lot:~¿I.:S
square feet
OJ.
u
Closest distance between nearest existing structure and upland
edge of wetlands:~UI£. feet
Closest distance between nearest proposed structure and upland
edge of wetlands: </2- feet
Does the project involve excavation or filling?
No
)(
Yes
If yes, how much material will be excavated? .3(;:C:) cubic yards
How much material will be filled? ~
cubic yards
Depth of which material will b2 removed or deposited:~ TO 2-
feet
Proposed slope throughout the
area of operations: In~FT ~ ~
/
Manner in which material will be removed or deposited:
l1tfEE r:s À M!:il\l(f) AT ELEVi1IJ:mJ /7. 5
T{) &:u-fDc£D TO 12-(; V41Jkhl IS" TD 12-'
L TO ßE (J:;:f--:LAs f~ t-ILL
IÎPtv.JO
f.-
S atement of the effect, if
waters of the town that may
operations (use attachments
any, on the wetlands and
result by reason of such
if appropri2t.e):
tidal
proposed
NO EFT£Lí I !M-ûUlt4ß/CÁ,{¡
Fe£>tJ.. VJ£:r LAtJO
35' liD ~ ¥:i.JfIiL
3
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14·16-4 ~"'95J- r-<:Ixt 12
I PROJECT '-D. NUMBER
617.20
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)
SEaR
3 PROJECT LOCATION:
2. PROJECT NAME
H 5I
Municipality County ~
4 ~TML1fATrõæ;~ 7Ge:s~o:d~iisec"ons, prominent landmarks. etc., or provide map)
~
~
NO(2..ï14 ~Î ~ CF i)g,r"MlTß.JE u:.4'SQ..L~"Œ p:t;~æ uJ
5. IS PROPOSED ACTION:
New 0 Expansion
o Modification/alteration
6 DESCRIBE PROJECT BAIEFL Y:
z.. 6TC$! 5rN4L£ ~ D.LJç/ / TNt¡
¥JP"~ 'lJr=u- ~ ~~t..( S-Pít=M.
7 AMOUNT OF LAND AFFECTED:
Initially .40 acres Ultimately . 1..[0 acres
8. W3 PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
þ(.I Yes 0 No If No. describe bnefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT?
~ReSidenlia¡ Dlndustrrl,1 0 Commercial 0 Agriculture
Desc';be ll'£e ý tt fZ- AC2.ft. ~L£ FAMJ.L'f'
o Park/Forest/Open space
~
o Other
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY ¡FEDERAL.
STATE OR LOCAL)~
DYes IpLNo If yes, list agency(s) and permit/approvals
"
DOES ANY ~CT OF THE ACTION HAVE A CURRENTLY VALlD PERMIT OR APPROVAL?
DYes }ð\NO If yes, list agency name and permit/approval
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
o Yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Appllcanllsponsor
Dale 4 - Z 7 - 'î 'Î
Signature:
If the action Is In the Coastal Area, and you are a stâte agèncy, complete the
Coastal Assessment Form before proceeding with this assessment
OVER
1
.
.
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-18f2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
WtY.J.:_J{..EL~_'f-__"r__.$.lU::Lbß!t S (/(0 ¡¿~K (
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, eJtU £.1t1 -5 µu c.-f, residing at 2'23"'5 ~ ¥ t::t2.-
be~¿[i':2!;[Jd~~ and say:
That on the '[ day of 0u....:9!~ 19~" I pers9n¡¡,1~ EOf;ted" !-hEh.
property known as !0L1.0 ~~)7:f:,.J~ ~ .'t::15J....>7#ClL1J~
by placing the Board of Trustees official poster where it can
easily be seen, and that I have checked to be sure the poster
has remained in place for seven days prior to the date of the
public hearing. (date of hearing noted thereon to be held nL'-I' øt~ If?f
()AJ off I'1lJoU.,. 7: I r¡ø"" T
Dated:
Swor~ to before me this
:&~ay of ~~ 1999
0~/fl ~
Notary Public '
HELENE D. HORNE
Notary Public, State 01 N_ York
No. 4951364
Qualified In Suffolk County
Commission Expires Mey 22. ~ ðd (
. .
Form 3800, April 1995 PS Form 3800. April 1995
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PS Form 3800. Apnl , 995
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BO~ of Trustees Application 4IÞ
County of Suffolk
State of New York
VJr u.L1v..A <5, Y ¡;. ; , L--( BEING DULY SWORN
DEPOSES AND AFFIRMS ~/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL
WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION
AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES.
THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. "
¡fI1
SWORN TO BEFORE ME THIS
DAY OF ~Y1 q
,19 S9
ef~m~L
otary Public
LYNDA M. BOHN
NOTARY PUBUC, State of New York
No. 01 B06020932
Qualified In Suffolk County
Term Expires March 8, 20 ru
7
.
.
PART II_ENVIRONMENTAL ASSESSMENT (To be completed by Agency)
A. DOES ACTION EEl'~ED ANY TYPE I THRESHOLD IN 6 NVCAA, PART 617.4? If yes, coordinate the review process and use the FULL EAF
o Yes No
B WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACT!ONS IN 6 NYCRR. PART 617.6? If No. a negative declaration
may tie supersef;1",bY another Involved agency.
o 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 ]eveI5. eXisting traffic palterns, solid waste production or disposal.
potentIal for erosion. drainage or flooding problems? Explain briefly
1J0 , . -.
C2. AeSlhatic, agricultural, archaeological, historic, or other natural or cultura\ resources; or community or neighborhood character? ExplaIn briefly:
No .
.. , ..
C3. Vegetalion or fauna, fish. shellfish or wildlife species. significant habitats. or threatened or endangered species? Explain bnefly:
. -' .
N 0
C4. A communlty's existing plans or goals as officially adopted, or a change In use or Intensity of use of lanû or other natural resources? Explain bnefly
N 0
C5. Growth. subsequent development, or related activities likely to be induced by the proEosed action? Explain bnefl'l
pJÖ
C6. Long term. short term. cumulative, or other effects not identified in C1·C5? Explain briefly
rJ d
C7. Other ,mpacts ~including changes In use of either quantity or type of energy)? Explain briefly
,j d
D. WILL THE PROJ~(HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CEA?
DYes 0 .
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
DYes 1NO If Yes. explain bneflY
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 occurring; (c) duration; I.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 idenlified and adequately addressed. If
question D of Part II was checked yes. the determination and significance must evaluate the potential impact of the proposed action
on the environmental characteristics of the CEA.
SfP rL tHO ÙJ
~
D 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 andlor 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:
-rr;W¡J (JOftR'o ð+ -¡¡¿uJ 76:-e-s;.
N.lme ot l!"".:JJ .I,>;:ent,
'tl ~~ I >:r~. 12/'(. I:$ft) êAl"7'
,(er In L<:'.ld TLtle 01 Re,pùn~Lble Drllcer
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2
APPr.t~^N'l'
TRANSACTIONAL DISCLOSURE PORH
.
.
The Town of Southold's Code of E~hics Þtohibihs conllic~s or
in~ereB~ on ~he ar~ of ~own officers and em 10 ees. The
ur OBe of ~his form is ~o rovide informa~ion wh ch can
alert the town of poss ble conflicts of n~etest and allow
it ~o take whatever action is necessary ~o avoid same.
tOUR NAHR.
'" .,- ;I'~i.·.:t~~ ',,1,.
.,.-,.,,'¡..,','..,...., . ,,' ,
. ,:.'.~'4-. -,..~'"'l· '. .
.
Last name, first name, m ddle
you are applying in the name of someone else or
other entity, such as a company. It so, indicate
the other person's or company's name.)
" .
~'....., """~"'';'''''''
.;. ,,',. . ..:.,:,' 4<~, ft!'4~t~> ~f{f.
".... ,'" .
NATURE 0' APPLI~^TIONI (Check all ~ha~ apply.)
Tax grievance
Variance
Change of zone
^p'p~~al of plat ,
ExedipHon fr0ll'nJ!.l...JI,t. ~I\-...0Ws;¡.i~.t map
other ~~
(If "other," name ~he activi~y.)
Do you personally (or through your company, spouse, s bl ng,
parent, or child) have a relationship with any officer or
employee of the Town of Southold? "Relationship" includes
by blood, marriage, or business interest. MOusiness
interest" means a business, including a partnetship, in
which the town officer or employee has even a partial
ownership of (or employment by) a corporation in which
the town officer or employee owns more than 5% of the
shares.
YES
NoL
If you answered ·f8S,·. complete the balance øf this fotm and
date and sign where indicated.
-..J'"
Name of person employed by ~he Town of Sou~hold
Title or position of that person
Describe the relationship between yourself (the applicant)
and the town officer or employee. Either check the
appropriate line A) through D) and/or describe in the space
provided.
The town officer or employee or his or her spOUse, sibling,
parent, or child is (check all that apply),
AI the owner of grea~er than 5% of the shares at the
corporate stock of the applicånt (when the applicant'
is a corporation),
B) the legal or beneficial owner of any Interest in a
noncorporate'entity (when the applicant is not a
corporation),
c) an officer, director, partner, or employee ot the
applicant, or
D) the actual applicant.
'i
,
DESCRIPTION OF ItELATIONS!I1P
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