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HomeMy WebLinkAboutTR-5890 James F. King, President -``��F suoryo Town Hall Annex Jill M. Doherty,Vice-President h0 54375 Main Road P.O. Box 1179 Peggy A.Dickerson * Southold,New York 11971-0959 Dave Bergen N Bob Ghosio,Jr. � �� Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 10, 2008 Mr. James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 RE: STEPHEN MATTEINI 1060 WILLOW TERRACE LANE, ORIENT SCTM# 26-2-22 Dear Mr. Fitzgerald: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, December 10, 2008: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit #5890 from Neil Stronski & Patricia Perez to Stephen Matteini, as issued on April 24, 2004. If you have any questions, please contact our office at (631) 765-1892. Sincerely, v o� James F. King President, Board of Trustees JFK:eac Proper-T Permit Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935-0617 (631) 734-5800 November 17, 2008 D EC E E President Nov 18 2008 Southold Board of Town Trustees Post Office Box 1179 soutri; Tow Southold,New York 11971 Board of Trustees Re: Transfer Permit No. 5890 and Permit No. 6723 Dear Sir: Please transfer to referenced permits back to Stephen Matteini from: Neil P. Stronski and Patricia M. Perez 24 Tanglewylde Avenue Bronxville,NY 10708 The sale of the house was not consummated. A check in the amount of$100 is enclosed. Si re*Fitzger. es E ' cc: Stephen Matteini -2G-�-aa a subsidiary of THE PECONIC EASTERN CORPORATION James F. King, President ��F S00Tb Town Hall Jill M. Doherty,Vice-President ��� �l0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G Q i� Telephone(631)765-1892 Bob Ghosio, Jr. lyCt7U Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 16, 2008 Mr. James Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 RE: NEIL STRONSKI & PATRICIA PEREZ 1060 WILLOW TERRACE LANE, ORIENT SCTM#26-2-22 Dear Mr. Fitzgerald: The following action was taken at the Southold Town Board of Trustees Regular Meeting held on Wed., April 16, 2008: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#5890 from Stephen Matteini to Neil Stronski & Patricia Perez, as issued on April 24, 2004. If you have any questions, please contact our office at (631) 765-1892. Sincerely, o°l ' Jame . King President, Board of Trustees JFK:Ims James F. King, President o��oF snuryo Town Hall Jill M. Doherty,Vice-President ti 6 53095 Route 25 P.O. Box 1179 Peggy A.Dickerson Southold,New York 11971-0959 Dave Bergen G ♦ Telephone(631)765-1592 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 18, 2006 Mr. James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 RE: 1060 WILLOW TERRACE LANE, ORIENT SCTM#26-2-22 Dear Mr. Fitzgerald: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, October 18, 2006: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit#5890 from Helen W. Keith to Stephen Matteini, as issued on April 24, 2004. If you have any questions, please contact our office at (631) 765-1892. Sincerely, o� Jame/F. King President, Board of Trustees JFK:Ims Board Of Southold Tom Trustees SOUTHOLD, NEW YORK PERMIT NO. DATE: 04 ISSUED TO ....HELEN W.. KEITH ............. ................... ... ............................... 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 To" Ordinance an- fitled ."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 ZIA. 2.001., and in consideration of the sum of $._.25_0-00 ... paid by Helen W. Keith . ........... .................... .......................;........... ........ of ...... Mattituck N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland permit to construct a new residence with a pervious driveway, with the condition of a 10' non-turf buffer landward of the bulkhead and as depicted on the survey prepared by Joseph A. Ingegno last dated March 29, 2004. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF. The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this data. KIN �'lRVEv OF �� I.M :' n 11 0 L(). , I TE_,1 HOLE DATA yr)r O/ \\ "'•'wr. " nwn it\[ No SWI ill[ 40W.." 2, I96Y CAT TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YOMY S.C. TAX No 1000-26-02-22 ;CALF I'_Su OCTOREF 6, zoos l t'��x1C` e,.� ✓� pp. ARE. 0 SB)5n I a9 II ([[VII OXS Iq[ q[r[pR U 4 ' 919 O..U4 c1o11,1 TIC N AR,AI slwo Q D [rmsc r Y I [P j@ ,{ ynf: \ 3 f T �" . i�`. `t� '1, D "O IAw a �AwcE[s nq I .o . e.um,o4 Ral sl s �c r..la,n sA Z 0 wuA LEACR Xc s s[X roq A - .o A""Co'.-"Sr IS eoo,z„.01N.11 Aq[A .oars.R occ•. 9 .., '00 o Q f I TIC u ..o.osm r - 4. f91f' .:-7 r o T 4 .d1 o a ax n[. A,.,.y„ ,XONx N[vra4 Aq[ rgoY n nR nox s[w. s wa/oq o A A,N[. ,R «•N[qs -'\ a \ \ •'>y 1i �• naac zoN[ sroxvAl a. , r o iooc IYsceAec A K . s mcwMe c T. \ ,g e. O _ ♦ H wIL Al TLc iun. 9y \ 1.\JA,� a. \ R tl lU N4 C LAW[1nu.0.5 22 ([a ae �/ 2 0 .R 5,l% u J1A• p,AF(ILA . D 6 C 6 9 V l4 «u.oq poor nr15,R x n` r' APO ,,_� ..... •e .. s. 4 . 6� 1' 0/. Oi yt, s „s h A. Ingegno - La d Surveyor ,.anrzXv o- or R, RCARINTFrD AA +� orry I IITc ue 13 s 5r u .>, r I �91 a a, , ,au COUNTY OF SOFFOLK © e °' Son OLD warn,No Ned Property T.Service Agency S ova .. - ....o.., .. .. rnn,Y umw m..aagxr mor u _ �26 °v IppO reov[xrr . 0 Proper-T Permit Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935-0617 (631) 734-5800 March 17, 2008 pECE E President Southold Board of Town Trustees MAR 2 1 P008 D Post Office Box 1179 Southold,New York 11971 Southhold Town Board of Trustees Re: Transfer Permit No. 5890 and Permit No. 6723 Dear Sir: Please transfer to referenced permits from Stephen Matteini to: Neil P. Stronski and Patricia M. Perez 24 Tanglewylde Avenue Bronxville,NY 10708 A check in the amount of$100 is enclosed. Sincerely, J es E. Fltzgeral cc: Stephen Matteini / a subsidiary of THE PECONIC EASTERN CORPORATION u W • Date a� � - � 045294 Received From 1 C c`7 OAddress • 0 cw y m Dollars$ O o o For LL. 5 oz §Q N ACCOUNT • • PAID Q ~ A T OF C/SM ACCOUNT mAMT.PAID /y CHGPEDECK I� C'� BALANCE W' I MMEI {( .iLpl"Cn.I Vl /V�.•y`�/yRy DUE James F. King,President o�aoF souryo Town Hall Jill M. Doherty,Vice-President 53095 Route 25 yy P.O. Box 1179 Peggy A. Dickerson T Southold,New York 11971-0959 Dave Bergen G Q 'Q • �O Telephone(631) 765-1892 Cow,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0161C Date October 19, 2006 THIS CERTIFIES that the single-family dwelling,driveway& 10'non-turf buffer At 1060 Willow Terrace Lane, Orient Suffolk County Tax Map # 26-2-22 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 3/25/04 pursuant to which Trustees Permit# 5890 Dated 4/21/04 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a single-family dwelling, driveway & 10' non-turf buffer The certificate is issued to STEPHEN MATTEINI owner of the aforesaid property. Authorized Signature • James F. King, President O���F souryo Town Hall Jill M. ]Doherty,Vice-President h 53095 Route 25 yy P.O. Box 1179 Peggy A. Dickerson T Southold,New York 11971-0959 Dave Bergen G Q �O Telephone(631) 765-1892 �yCoorm a . Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD October 18, 2006 Mr. James E. Fitzgerald, Jr. Proper-T Permit Services P.O. Box 617 Cutchogue, NY 11935 RE: 1060 WILLOW TERRACE LANE, ORIENT SCTM#26-2-22 Dear Mr. Fitzgerald: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, October 18, 2006: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Permit#5890 from Helen W. Keith to Stephen Matteini, as issued on April 24, 2004. If you have any questions, please contact our office at (631) 765-1892. Sincerely, o'l Jame F. King President, Board of Trustees JFK:Ims Proper-•T Permit Services POST OFFICE.BOX 617, CUTCHOGUE, NEW YORK 11935-0617 (631) 734-5800 October 3, 2006 President Board of Town Trustees Town of Southold Town Hall, 53095 Main Road Southold,New York 11971 Re: Transfer of Permit No. 5890 Dear Sir: Please transfer Trustee Permit No. 5890 from Helen W. Keith to Stephen Matteini, the present owner of the property. Our check in the amount of $50 is enclosed. ly, J es E. Fitzgeral r. a subsidiary of THE PECONIC EASTERN CORPORATION wf Board Of Southold Town Trustees SOUTHOLD, NEW YORK I PERMIT NO. DATE: . ,._pril ..11, 2004 . ........ ISSUED TO ..........H.E.L.K.N. ..W.......KEITH.............. ... ... ........ .............................. ........ .. .. .... .... .... .. Aut4orizatit 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 an- 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 ..April ZIA.. 2004.., and in consideration of the sum of 00 paid by Helen W. Keith . .... .. . ................... .............. .. . ............................................ ......... of ... ... Mattituck ... N. Y* and subject to the Terms and Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Wetland Permit to construct a new residence with a pervious driveway, with the condition of a 10' non-turf buffer landward of the bulkhead and as depicted on the survey prepared by Joseph A. Ingegno last dated March 29, 2004. all in accordance with the detailed specifications as presented in the originating application. IN WITNESS WHEREOF. The said Board of Trustees hare- by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of this data. U'3 Timfees ........ ...... it TERMS and CONDITIONS 1% pest Helen Keith residing at 995 Willis Creek Dr. , Mattituck N. Y as Y part of the consideration for the Issuance of the Permit does understand and prescribe to the fol- lowing: 1. That the said Board of Trustees and the Town of Southold am released from any and all damages, or Balms for damages, of spits arising directly at Indirectly as a result of any oper- adoo performed pursuant to this permiq and the acid Permittee will, at his or her own expense, defend any and all such wits initiated by thhd 4pardes, and the said Permittee assumes fall 11.bMq with respect thaeto, to the complete e:dnsion of the Board of Trustees of the Town of Southold 2. That this Permit Is valid for a period of Z4 moa. which Is oohddaed to be the estimated time required to complete the work involved, but should dramatances warrant, request for an extension may be made to the Board at a later dates 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained 4. That the work involved will be subject to the inspection and approval of the Board at Its agents, and non-compliance with the provisions of the originating application,may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein auidsoraed. G. That there shall be no interference with the right of the public to Pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alwattions In the location of the work herein aathodwd, or if, in the opinion of the Board of Trauees, the. wort shall cause unreasonable obstruction to free navigation, the said Pmaittee will be required, .upon due notice, to remove or alter this work or project herein stated withaa_expenses to the Town of Southold a. That the said Board will be notified by the Permitter or the completion of the wort anth- . orized. 9. That the Permittee will obtain all other permits and consent that may be required op- plemenml to this permit which may be subject to revoke upon f llssm to obtain same. Albert J.Krupski,President Town Hall James King,Vice-President C 53095 Route 25 O1 Artie Foster ,r0 P.O.Box 1179 Ken Poliwoda = Southold, New York 11971-0959 Peggy A. Dickerson Z Telephone(631) 765-1892 W Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. ` INSPECTION SCHEDULE Pre-construction, hay bale line 15t day of construction % constructed roject complete, compliance inspection. OgUfFO(,� Albert J. Krupski, President Q� C OG Town Hall James King, Vice-President =� y� 53095 Route 25 Artie Foster H - P.O. Box 1179 2 Southold, New York 11971-0959 Ken Poliwoda Peggy A. Dickerson 'yiffo aQ`- Telephone (631) 765-1892 1 #/ Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 21, 2004 Mrs. Helen W. Keith 995 Willis Creek Dr. Mattituck, NY 11952 RE: 1060 WILLOW TERRACE LANE, ORIENT SCTM#26-2-22 Dear Mrs. Keith: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, April 21, 2004 regarding the above matter: WHEREAS, HELEN W. KEITH applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated March 25, 2004 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on April 21, 2004, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, z 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 approve the application of HELEN W. KEITH to construct a new residence with a pervious driveway, with the condition of a 10' non-turf buffer landward of the bulkhead and as depicted on the survey prepared by Joseph A. Ingegno last dated March 29, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) Fees: $100.00 Very truly yours, d �z4 Albert J. Krupski, Jr. President, Board of Trustees AJK/lms i �O�oSUFFO(,��oGy � Town Hall Telephone y 53095 Route 25 (631)765-1892 P.O.Box 1179 oy'y01 � Sao Southold,New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, April 13, 2004, the following recommendation was made: HELEN W. KEITH to construct a new residence with a pervious driveway. Located: 1060 Willow Terrace Lane, Orient. SCTM#26-2-22 The CAC did not make an inspection, therefore no recommendation was made. SUFFO(K I Albert J. Krupski, President Q�� C� Town Hall James King,Vice-President ='� � 53095 Route 25 Artie Foster o P.O.Box 1179 Ken Poiiwoda N = Southold, New York 11971-0959 Peggy A. Dickerson �,�O � Telephone(631) 765-1892 j Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUT14OLD Office Use Only Coastal Erosion Permit Application _�_ tland Permit Application _0_ 'T,lajor Minor Waiver/Amendmen Changes _'Received Application: 3 Z _.Received Fee:$_!;�WA _completed Application_ —Incomplete____—____ _ SEQRA Classification: r6o3rd 1, LIE Type I _U __Type [[, nlisted__ Coordmation:(date sent)_18AC Referral Sent:_�te of InspectofCAC RepoII: _ _Lead Agency Determination:__ Southold Tuwn __Technical Review: of Trustees /Public Hearing Held �� Resolution: Name of Applicant r eAA,_ W - Ke Address CKL'�"� ��P&V_ la(� tJ tft� caC1j�J\% (t�( �YC SR 'YP _Phone Number:( ) (P31 xc - fsc! _ Suffolk County Tax Map Ntunber: 1000 - Property Location:_ LCUIap L i) t l)12" 1 ev✓d.GC' 4"j T uac,",.+ lo-f-- cvl/ f4ti Rkm l ofu ie✓✓ -Q_- Hd-vQ- (provide LILCO Pole#, distance to cross streets, and locatio ) �iviS q—� K,vlld Sf+giti' AGENT:- (If applicable) Address: Phone: �oard of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: ►2 alp Previous use of property:C , VI'tc'j L0'� Intended use of property: PeS,! t,,,"e_(w In, "% tw/. l I Tll^< S(Owtp- (95 1~ f ! iI z b�"U- kwA Q S Prior permits/approvals for site improvements: Agency Date I�lv�}, r Ju,U.°tiI% 19C9 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? -A,_No Yes If yes, provide explanation: Project Description(use d�attachments if necessary): 1 rc y 64MS+Vv — CsL r�G�.V ��S•��I[i Wl l •1 tip l!�`fUtdO •� ayllL+"' 't W r-N,,,n A bucl.V S Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 60v\ .) �Wct &-, 61 fU h ant,:-- Area of wetlands on lot: square feet Percent coverage of lot: o % Closest distance between nearest existing structure and upland edge of wetlands: /�ed Q feet Closest distance between nearest proposed structure and upland edge of wetlands: 7 S, 5) feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? %51co cubic yards(,/ln ab 4,. k x ` 1 x How much material will be filled? cubic yards Depth of which material will be removed or deposited:2(_feet Proposed slope throughout the area of operations: ov-Q, Manner in which material will be removed or deposited: bjavoF [L t vuc It 1 c'iy,se,�P� t, 064 "idA S .fie, Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): `U ' 10- dUml Jeta es-<< i-via h u l V 1A ul amls ovA � �V�l a2& 13-16-4 I21071-7ext 12 PROJECT I.D. NUMBER 617.21 S EO Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART [—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) t. APPLIC' (SPONSOR 2. PR JECT .VANE 0. PROJECT Mi LOC1 / County.ncIp.ltY L " S j F a. PRECISE LOCATION (Street address and road iiiiinsections. prominent IanamarKs, etc., or prove a mapl /041c (�Ci,l(axtTe� rsL¢� l.cQxA_, C� t�hLl<' ( ctitlL] U(L ecL� lvrt' �/�:fin LIU, lke),u �wfeg_ Nam_ ,< I�vl1 ��µ � +Ivio 51 �ii S t l2ZAL es Jiftz te 5. IS PROPOSED ACTION: LLFy ew ❑Expansion ❑Moamcatlonialteration 6. DESCRIBE PROJECT BRIEFLY: 1 610v�Stvjc*— 0-. QCsr.At'nc,?_, LQJl tR +� tG>s C�VLLtp�ayy f LtiL�VItn 7. AMOUNT OF LAND AFFECTED: Initiaily t acres Ultimately acres 3, WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING 'SAND USE REBTRIC-IONS' XYes No It No, describe bnerly 9. WHAT IS PRESENT LAND USE IN VIC:NITY OF PROJECT? )N�Res,denti.i ❑?nausinal ECommercial ❑AgrICWture =ParKlFore$VOoen soace ^Other Des1EAe: �I 1 !w-9- ✓lAtl w IA S ibvu e� ci (Gi�LGl — l v1tS i S tt o_ a, lti Y &C ,,,k I E, -. 1 V 10. DOES ACTION INVOLVE A PERMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY iFEDERAL. STATE CR LOCAL(? oyes L No If yes, :ist agency(s) and permitiaoprovals I u" !:G b16 s J04raL a! W Lv L iu,- �, mil✓✓L S,�l c;� w� , clpyl L c as�c tvL it. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR .APPROVAL? 0Yes ❑No If yes, list adenoy name and permiVapproval 3U►�, te@s was-e., c1�s�t.C�.- b•cI t7�-.e_i ws�•s �h l�(�'`f �wd- ��-E- 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMITIAPPROVAL REQUIRE MOOIFICATICN? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE 70 THE BEST OF MY KNOWLEDGE Applicantisponsor name: Dace: Signature: If the action is in the Coastal Area, and you are a state acency, complete the iCoastal Assessment Form before proceeding with this assessment OVER PART I—ENVIRCNME 1-A WSNIENT J ,a c-=z,e!ea Dy A'yen.C" • A. JGaz ACT:CN EEC=E' 1NY =E. -r•Rc..rC LD 'N i N'r CR.R. c-AT i:,-.':' ,f res. :ocromats :ne review -rocess and ase :ne .,is •JO E. 'NILL +CT;CN REUS:•r_ c..CRCIN,ac7 REVIEW >S R?CVIGED =c: UNLSTED _..`CNS :N 3 AYCn R. oAA7 i.,'.=� f •t o. a e-,c:,e Cec:ar may me sucersedec my anctner.nvolvea agency. _Ye ANo C. CCULO ACT:CN RESUL7 N ANY ADVERSE E='E._ 3 ASSCC;ATED ,PITH -- ?'3LLC .'-r svING. :Answers ay me iaricwnn G e,. .t eglel Cl- Edsiing au ;uanty, surraca or grounawater auan y or ouanuty, neae Bevels. ex:s:mg attic ,acerns. solid .vas:e orecuc::cn or clsc- oc ennal 'cr ±ros;on, oramage Or 'IOOGng proclems'.' L-,ica n Jnerfy: ►j10 C2 ?esthetic. agricultural, arc.^.aeOloglcal. ]Isidro. of Omer natural or cultural resources: or community or leignocrn COe c:aracter" Exclaln ]. n10 .].:. regetapdn or fauna. 'isn, sredfisn or•xddlife species. signiricanr nactatc, or :nrearened or endangered sCec:es? Ex Clain ortal]•c 'x/ V C-1. A ccmmunay's exisung plans of;Oats as offic:ally ddocied.or a orange in use or Intensity of use of land Or other natural resources? Explain ]. CZ. 7rowm.��eeuent iai,elooment. Or related ac:ivitles Iikety to ce Inaucea oy !ne ]roeosea action? cx Olam Oneily. iJ '_tong term, snort term. _umwauve, or Omer Bred=not IcenWiea in C:LS? Exvam diet Pl. / V -Ines ��mc�ac�:s ,tm,c:,o:nS _-ang es n -use or .!toner auantily or ;ype Or energy)? orleil, ��J t,U-43� ` Q, 4(40 iw— t �t1L_ -C SE DCHTRCVEESY aEUTED 7o °CT_NTIAL A.,,_ ..,E °.V,IRCNfn ENT-'L :,!PAc7S? _ yes ;<Iio 'f "es. exclam oneiN ?AST III—DETE.'.MINATICN OF SIGNIFICANCE iTo De conoletea by Agency) INSTRUCTIONS: For each adverse effect identified aedve,determine'.vnetner it is suestantial,large.:mcoriant orothersise signific Eaton ettect snould be assessed m connection with Its (a) setting (i.a. urdan or rural); (b) ?rodaodity of occa--ing; �C) duration Irreverslodity; let geogracnic Scoce; and in magnitude. If necessary, add attachments or reference Supporting materials. Ensure exclanations contain sufficient detail !d snow that all relevant adverse impacts nave been identified and ddeg Uateiv addressed. _ CSeC!( This Cox :f /oU have identified one or more -otentially large or significant adverse imoac:s whic ',IA" occur. :hen orocaea directly ro :ne FULL EAF analor prepare a positive-ceclarancn. Checx ;his cox 'f you nave determined, baS2a on the information and analysis above and any sUoeort;nc eocuraentaricn. tnar :be Croeosea aC:ien 'HILL NOT result in_Inv significant adverse environmental imoacc AND provide on 3itacnments as necessary, the reasons supcorring rhlS determination: I `i.nni tt _i,iJ '•Serf', ,mi y vi,c ..mB Ji (Crpen4nlp,.IiKH n .Bea 1111C, :rile JI (c:ponvale Wr'ttr :,cn�iwe v tr.ean..e�r :inch n _ua wrncv i ¢n a:urr a /wro. Ir _ie c•ma :min resaon imm pincer, J,ce PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: II Address: uJ liaw . h�aYl�> Jr. 9 (0e.) U,','t(su.0 T�vv<t.0 �.cktie u� L-evvt IVV N1Y� . �i66i�lM �BgmL ii p f M1 b S ZJ O O �llL$t- 1�(9-J �•Jv' u l ��� �t IF-�: ve,�o Rkt", F1- 3y1�7 STATE OF NEW YORK COUNTY OF SUFFOLK V� lJ z residing at Q Q.( W ([LSG d e elL yi t y 2 1 l 1/being duly sworn, deposes and says that on the _�jj day of 20 , deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment rpJ°ll of the Town o�Southold; that said Notices were mailed at the United States Post Office at R&.*it-\-)LIL AN that said Notices were mailed to each of said persons by (certified) (registered)mail' r c L�v Sworn to before me this �A' Day of C—)1 AJt._ , 206 Notary Public PATRICIA NOIM7 d�York 0 is IL ml u I )01 Y m 05 - ----J S FED n ON Lr- rL pT 1, rn p Fsuns p -_�m Isne of r'rrc - n e N Er .;,morHr,Pi nai � h p R rt;aa.ee.En m uCJPs m _ _ o c/ lll�h 4 r (•IulsN -..- 14 -:.n SI�OL _f�C }?lv.✓ l,r rllt��v w'-- .. rt- • SpFFO(�- • Albert J. Krupski, President O�0 ek Town Hall James King, Vice-President h'1` Gy 53095 Route 25 Artie Foster p P.O. Box 1179 Ken Poliwoda ti Z Southold, New York 11971-0959 W Peggy A. Dickerson �,j. Telephone(631) 765-1892 Faxi.631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ►he�h-------------------------- COUNTY" OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING �brrt Lo residing at qq j L0 , l� `S CV;eC,iL being duly swom, depose and say: That on the 3 day of 4f ` , 2004 I personally posted the property known as ;1� 41C W, how i�'J✓ c.,:_. l c h �h�' I eo-r , /l!*%/ by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held'"` n a R a bout 0"00 Fyn. Dated: (signature) w orn to fore me t 1 day R�� . �0 tart'Public eronica F. Cldone APR D Notary Public, State of New York No: 52-4661406 Southold Town Qualified in Suffolk Count, Board of Trustees Commission Expires DeC.31, r • Board of Trustees Application County of Suffolk State of New York 4e—k ,1 lam . V,e 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 HISMER 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. J i Signature SWORN TO BEFORE ME THIS DAY OF c ,20� Notary Pu is MARIE A.WOODS Notary Pidic S'a!e of New York No.s•vdOSD?itSo Oux.h is Sua_%:v Gounty My Oc-re ission E-irc;Aug.15,20 • 0 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. E YOUR NAME: 9,r_ t"t ``t��1 W . (Last time, fi t name,middle initial,unless you are applying in the name of someone else or other entity,such as a company. If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other r 1 r, L (If"Other",name the activity.) WeJ1dtd Ne Vm.�"' Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest. "Business interest'means a business, including a partnership,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 NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)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): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 200+ Signature Print Name P� 2 inW I I e,r g11FF04 Alberti.Krupski, President 0� CD Town Hall James King,Vice-President h 53095 Route 25 O P.O.Box 1179 Artie Foster �y Z Southold, New York 11971-0959 Ken Poliwoda Peggy A.Dickerson Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: n Kl It h Please be advised that your application dated has been reviewed by this Board at the regular meeting of 11 IAI I 0 and the following action was taken: (__,./fApplication Approved (see below) � ) Application Denied (see below) Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: l` C QCl W ,PJ14- -0o/wtjj.Ae�n J 6( 00 c no�Cc ru ILES Date, 041991 Reublved From Z 3 h v z Dollars$ Or 0 8 .For 51 c £ CD�rACCOUNT HOW •• D m o CCOU � O AccouHr caaH: m AMT.MID C ECK BALANCE EY ORDER CUE IT WO F j4 21 cl) F7 Sl'kY'F:Y OF LOT ev, 1 ' O IIO"!' 1 TZ',7 HOLE DATA 1 70 "r.r I,,,Ri— — _ N.al OJ N, M 1 ,D Q �-r,N >fF••EMIRI+ ". :r4,{J WfLirOW TFfMA( T Y .ti'F(•TI(71 (LVF 'TIN, I FILE No 5407 TILED NOVE MBER 28. 1969 'o k- I11,9T('D 47' T)I? F:,N'1 TOWN OF SOUTHOLD 6`1 ^ SUFFOLK COUNTY, NEW Y010 S.C. TAX No. 1000-26-02-22 SCALE 1 "=30' 1 OCTOBER 6, 2003 PGP �, r Vb n\\ °t V �� _ wPRr. w r-P'IwN ..vl 4.\F'LMNL6' 1 lµ.' F�it 'I,W[qr ll if 'I',lia ,(i.,'L't .� .r F- A 4,a,\ ' wlRp A3 �R. _ L s� IL)I� N ) - ` J� J' eiA G >R y`+pn aIP 1�aV 0 �0� 0O \-'9q? AREA = 16.875.31 sq H. a `q �•. .✓' H;,... 41e ,10.387 nc. n ELEVATIONS ARE REFERENCED t0 N G ✓D 1929 DATUM ✓" 9Cf, S - _ h ��- N ,�� - ; Cf1 FXISIING 11EVATIONS ART SHOWN THUS' EXISTING CONTOURS ARE SHOWN THUS p 6 J 1� ' MINIMUM SEPTIC TOUR FARE SHOWN S FOR A 1 e HOUSE'+pJ', Y 1 IANk 8 LONG. 4 -3 WIDE 5' IE E! D a BEDROOM H I IS IDOL' GA LONE. (" " Y ate. f`i.` l ' Z SYSTEM FOR A ' TO a BEDROOM HOUSE IS }UU sq n cDE WALL AREA \ Sr'' / 1/ p/. + 6� „ 1 \ /� 5. MINIMUM LEAL HINf, 5 O , POOES. 6' Of. B' if, 1 1 0 0 v \ n O O C y+,fM PROPOSED EXPANSION POOL qq ,„ 5 / \� = rJ� '�- O Jy r� -V Q PROPOSED LEACHING POOL 1aJ v g ;L; A PROPOSED Sr Prl ra Nl' r O [ LOCATION L_ Tf. ... .H UWh HJ ARE FRO M FIELD f r OBSERVATIONS 4N0/OR OAIAMRO mHERS_q J' F'!OOD ZONE INFORMATION -4KEN FRt1M. ✓' \ \ `�H '2° /' j0 �' ` FLOOD iNSLRANCE RATE MAP N_ i610300068 1, \ y `t _/ �� , ,� 4 NE 4RF_A-. , Spn rtAp ,i eH'A- n ❑I' ,1 dA rI VUU WITHG- \� . F` n P 1 r 1 4 1 .i ` J, ,\ lu ` O\ UiAGI VI !i, I b:'.!1A '4,\'Jd..L ti `,' St1 t , \ O, \ ` / f ; , 1 \'JIn F ",IV IuU "i 4F' < �C. - ''S �� (mod .'r,4f AN4 A: ')F iRMINFf l HT `Pf ,EAF : 000F 4rN ,0 6 81PLUrNG COVERAGE I .,85B ,G R 15 42% ,F TOTAL 10T AREA. �6 ! �'� \ Il \ f 9 %V `A� O DRYWELLS FOR ROOF RUN-')FF kOPt LVEb ❑RrwF1� wrlH RuriT n4UlR Ill," -.UHlywl wn r NNw PO UPI P. r1 NT. n-a•x -tart .NI APR - 1'+ l �nE' � L'-� 1 S Southold Town ~ ,y� Board of Trustees In- -r) 4 - _ ^/N+,ir1.Im[u; NrLwa rxm rw NJd iUN �'^ L� J '.NI NLW r:rllF "1111 Imo• 7/ h A. Ingegno x.fi No wr UrNrrAHIM. ',. ,r, ,,,, N1r •m�xxrrT. Lad Surveyor 'L R .Alm 'RbE No 4ptlf A-PrMJM iNplrP'FI. i. r Wr UN :M!t !V INE IlAo lI IXF Wypl 'wl f:;M9 mr'11EV4PAH 4Yl R ME Tk i IW lF DWPµ� (y/EIryyFN\4 .IfFTv_ WD M1fle `:onrrys ,JMnyn:p '..le °rnn. ndrn h.- if.A'AWG ASTFUrRY. 05lTV HEREON. .WG r, THE Ai4�NFE'. 'Y rENpN(. rN}T PHONE 1631"2/.2090 THE EXlSTERCE DF RIGHT! OF WA'S Ifr,_,r 4rn e ANV,OR UR CNI" U' PFCORD. 'r ANr, 401 SHDWN ARE ND, GU JIANTETD. F.11111 - L — __ - - _ _ _ 1<M RHf ACI, N,. Yml' •Ivp' O,eme,vl. Ne. � "lu', tqe'