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Home My WebLink AboutTR-5566 Board Of SoutholdTown Trustees SOUTH OLD. NEW YORK PERMIT NO. .5 f>'l.fø DATE: .. MayU.;·"z602 ISSUED TO .........~.c:>?.~.~...~...~.E:.~:r-.~.F,:.vi.J\l.~.. . .................. ......... ~utltnrilattnn 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 ßÖard adopted at a meeting held on ...~.".Y...?2..I...... . 29.9.2.... and in consideration of the sum of $.....2·00.-GO .... paid by .. J!'airVl",,,,~þ''''!...!3xºWg.p',,,:>Jg¡:¡ ...onbehalLof...Rog.e.r....&.·.I.,es}ie·· Walz . T~~~..~~~f'eë?n~~~~~liried..~~ ... ~ ~~v:: su~1e:t ~r::f. of Southold Town Trustees authoràes and permits the folowing: We~lan~ Permit to add second story to existing home mamtammg same footprint -no encroachment on waterside subject to Suffolk County Health Department approval - . IìrlOr to constructiol a line Q£ hav,balas-dr well i>. tt a in accordance with the detailed speC11lCaTIOnS ~ preéeme3'-tn ers . the originating application. . to retain roof_t.1.1I1.-;Q,fL IN WITNt:~~ wHEREOF. The said Board of Trustees here- by causes. its Corporat«: S~al to be a~xed. and these p~sents to be subscribed by a majority of the said Board as of thIS dat.e. .'l> TI"fISl'" TERMS and CONDITIONS . , , - The Pamittec RV5C.1 & Leslie Walz re-'~:qg at 1505 Old Orchard Road. East Marion. N. Y., .. part of the coosideratioa for !he /sSo........ of die PCrmit does a.,.d.øcaad 8nd prescribe to the £01- Iðwiøg: . 1. 'I1w the said Board 01. Trustees aod the TOWII 01. Sooc/ooId are IeIased &am ...,. aod aU daJuges, IX claims fOt daJuges, 01. IUiø uåiøg dhecd.y IX Iadincd7 .. a aaak 01. ...,. 01*- úÍOa peáoaaed pUnumt to chis permit, aod the IÙd 1'0 Ju"" will, at his or - OWD arc-. defend ...,. 8nd aU IUCh øts'nlol.-d by third pudes, aad the IÙd P 1.0,,,,, - faIlliIIIIIk7 wid> reSpect therero. to the CO"'p'- .~ of the Boatd 01. n..sc. 01. the Towa 01. S -4' ~ 2. 'I1w chis Permit is mid for . .perIod of 24 ...... wIdda is < CAp'·.... ~ eo be the ectI.......d âme'rcquired 10 cnmpl- the "II'Odt inwhoed, butiboald ~....... ---. ~ for an --.I"" may be ØIIde to the Board ar a ~ daœ. 3. 'I1w chis Permit sbould be rd:aioed iødefaoitely. or .. loøg as the øid ~ wishes to _.;....In the sttueture or project involved, to provide evicIeDœ to anyooe ",...<uled tb.t IØIb- .orizatioa .... original1y obtaiøed. 4. 1œt the wodciarol~ wi11 be subject to the ;...pea;on aod appron1 01. the Board IX its ageats, aod fIO<KOIII(>lJance with. the provisioas 01. the 00gi-,;"g appI~ øu.y be cause foe re\'OC&doo of this Permit by resoIudoa of the said Boatd. S. 'I1w there wi11 be no uamosonw1e interfaeaœ wid> aøigotioo .. a aaak 01. the WOIk baeia ..ïthorized. . 6. 'I1w there shall be 110 iøterfaeaœ with the risht 01. the public to pass aod ... úoag the beach between high and ~ water marks. . 7. 'Ibt if ·fuaue openrioas 01. the TOWD of S.-"I~oId re<pdre the -u aad/IX a1ttntioas iA the 1oao(Önn of the "II'Odt heœIa _lIu"td. or II; in the opiøIoo 01. the Board 01. Tmsœes, the. "II'Odt shaI1 cause unreasonable obstrucÞoo to free _Yigadoa, the IÙd P .. .I".~ wi11 be reo¡ahed. apoo clue aotiœ, to remove or alter this wod< or ptoject baeia lUted ~ ~.... OIl to the TOWII . 01. Southold. 8. Tbar the said Board wi11 be nodfied by the Permittee ot the [!..,.L ¡¡.". . 01. the work aath- omed. 9. That the Permittee wi11 obWn aU other pamits aod ov-ntf &bat øu.y be nqaired lOp- p1emeota1 to this penult which may be subject to revoIœ upon failure to obtain woe. ~-,.,.. Albert J, Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . .-.. Town Hall 53095 Route 25 P,O, Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 30, 2002 Ms. Amy Martin c/o FailWeather Brown Design 413 Main Street Greenport, NY 11944 RE: SCTM#37-6-5 Roger & Leslie Walz 2505 Old Orchard Road East Marion, NY Dear Ms. Martin: The following action as taken by the Board of Town Trustees during a Regular Meeting, held on May 22, 2002, regarding the above matter. WHEREAS, Fairweather Brown Design on behalf of Roger & Leslie Walz applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated May 2, 2002 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 May 22, 2002 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code, . 2 . WHEREAS, the Board has detennined 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 approved the application of Roger & Leslie Walz for a Wetland Pennit to add second story to existing home maintaining same footprint - no encroachment on waterside - subject to Suffolk County Health Department approval - prior to construction a line of haybales - drywells and gutters to retain roof run-off. BE IT FURTHER RESOLVED that this determination should not be considered a detennination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months ofthe date of this notification. If inspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: $10.00 Very truly yours, tl~ 9· /~ï~~ ç;t Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC Building Department . . Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Fairweather Brown Design on behalf of Roger e, Leslie Wa]z May 2, 2002 Please be advised that your application, dated has been reviewed by this Board, at the regular meeting of and the following action was taken: Ma.y 22, 2ððl (-2L) Application 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: Two Inspections @$5. 00 $10.00 TOTAL FEES DUE: $ 10.00 tlLIA.-1 ~ ¡({.. i··~' 9; SIGNED: y. PR SIDENT, BOARD OF TRUSTEES BY: WOe;) .w I 3 '¿[iGI 1 )) ___J/ ------- ---~-- 4/98 Albert J. Krupski, president. James King, Vice-President Artie Foster Ken Poliwoda Peggy A, Dickerson . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 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 1 st day of construction Yo constructed x Project complete, compliance inspection. ffi~ER & LESLIE WALZ . , Old Orchard Road East Marion, New York . . vJ~ INSPECTION SCHEDULE -0re-construction, hay bale line ~ 15t day of construction J Y:z constructed [!j Project complete, compliance inspection, --- · . Presented at the South old Town Board of Trustees Hearing on 5/22/02 Ref: Roger & Leslie Walz SCTM#1000-37-6-5 My name is Norma T. Martin. My husband, Ralph, and I live next door, to the west, of the Walz' house. Our interest regarding the proposed second story addition to the Walz' house is due largely to the additional bathrooms and/or showering facilities that will result. Since their house is at the highest elevation of the slope of land between our two houses, we are deeply concerned about the additional drain on. and possible overflow of, the sewage system. Should the existing system fail, which is a distinct possibility since it dates from when the house was originally built in 1950, the effiuent could not only spill over onto our property, but possibly leach into the existing water table, which is only 14.9 ft. from the sllrface, according to their surveyor. Inasmuch as we are currently in a major drought situation, according to the National Weather Service and the DEC, and the water table is at a low point, it could very well rise as this situation improves, making leaching into the higher water table a serious consider- ation. It could also leach into the nearby shallow tidal watelWay, which is only about 82 ft. from their property line. It is our understanding that the Suffolk County Department of Health has very specific regulations regarding sewage disposal systems and minimum septic tank area and capacities as set forth in their "Sewerage Disposal System for Single Family Residences, Sec. 5-120, Tables I, 2, 3 and 4. These regulations indicate that a residence having one to four bedrooms requires a minimum septic tank capacity of 1,000 gallons, with a minimwn liquid surface area of27 square feet. Also, with a depth to groundwater of 11 to 17 feet, a minimwn requirement of two pools-- each 6 feet deep and 8 feet in diameter or, three pools--each 4 feet deep and 8 feet in diameter-- are required. Will the Southold Town Building Department ascertain compliance with these regulations by seeking approval of the septic system from the Suffolk County Department of Health? Also, will the contractor that is selected to build a new system have a liquid waste license from Suffolk County Consumer Affairs? We understand that, according to William Baessler, Director of the Bureau of Licensing, a liquid waste license requirement is required for any business that hauls, installs or maintains sewage disposal systems in this county. Also, it was stated in the Traveler Watchman on March 14,2002 that Trustee Krupski was concerned about sewage leaching into the waterways of South old because the county is allowing septic system setbacks as close as 47 feet from the wetland delineation mark He asked the Town Board to place a rule in the town code that all septic tanks should be at least 100 feet away from the wetland delineation mark With the limited amount of space available on this small lot. it appears to be impossible to comply with that stipulation. All in alL it appears that this project could have a serious detrimental effect on the tidal waters nearby, as well as our adjacent property. Thank you for giving me the opportunity to voice our concerns regarding this proposed addition. Norma and Ralph Martin, Jr. . . Telephone (631) 765-1892 Town Hall. 53095 Main Road P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, May 20, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Scott Hilary, it was RESOLVED to recommend to the Southold Town Board ofTrustll" -mLJ~ .JAI,. of the Wetland Permit Application of ROGER & Lt;5UE WALZ to add a second-story to the existing dwelling, maintaininØIItI.lJtQJJì..,.~rl:iIIl'It. Located: 2505 Old Orchard Rd" East Marion, SCTM#37-6-5 Vote of Council: Ayes: All Motion Carried ~ , . F AIRWEA TIŒft-BROWN DESIGN ASSOCIATES, 1Ne. P.O. Box 521 413 Main Street Greeoport, N.Y. 11944 63t-477-9752 (fax) 631-477-0973 May 1, 2002 Southold Town Trustees Re: Walz SCTM# 1000-037-6-5 The accompanying application is for the addition of a second story to an existing single family residence, The proposed addition/renovation is to maintain the existing footprint and will therefore not cause any new impact to the wetlands, in fact there will less as roof run-off will be directed to dry wells. Hay bales will be placed as directed, during construction and as no ground breaking will be done on the wetland-side of the home. The only disturbance we foresee will be in the side yard (driveway area) where the septic system will have to be upgraded, according to SCHDS standards, and again proper care will be taken during this process to assure nothing affects the local wetlands, ··~1""'~-- -- r I ".;; m If r ,.,0 .~, .-.,,'J,.. - ri . . ," ~- - :.J ,L ¡ I ' ¡ ~.., ! 1/ .. - -.- - 'c '-'. ,j . i Uh ~~AY - 2 ~ ;5': '-4 ( .'1':'i10F SO' ïTH· , . r ----~u.~, . --.--.:.--- .: The home is above the 10' contour. This project has been tied up with the ZBA since May 14, 2001, with the revised interpretation of the setbacks. We have been told to expect a decision on or by May 18th, Thank you for your consideration of this application. If you have any questions or need other information, please do not hesitate to contact me or Robert Brown the Architect for this project. Respectfully submitted, . . " 'Y:>O"'~".~;;·.'~ "~"~":L")3M:·,J'.o,o... - "'';;''-''''C'-:' "- "';',-"'r~~,'~' .- ~ f.K 'X)"~J.5'~~ ___ ',,",-"-'\1:'.';) 3 '- -':~ y,l 1 ~ :.~k,/...[.;-".'~· I .1/ / I 1:1 'I . . ~I! tBtEHHc- tlliftEjjq In ',4' '_~r TRI'. SOUTH ,C"1O ._."z,O ìW' '?t.o~ LJ~,!>!f ~f..JÞr¡J 5. p"",ootor~ roo. (S"""",hoI roo ""'wo) ~~ WETLANDrrRUSTEE LANDS PERMIT A Wetland Pennit is required for any activities within 100 feet of any wetland or surface waters in the Town. The Trustee Lands permit applies to all moorings, piles, docks, bulkheads, and other in-water structures and activities. If you have questions regarding whether the Trustees have any jurisdiction over your activity, please contact the Trustees. The Trustees or their representatives will assist you in making this determination. The ~lication requirements for a Wetland/Trustee Lands Permit are as follows: ~) Complete application fonn, Fill out all items contained'in the sections identified as General Data and Wetlandrrrustee Lands Permit Data, Notice to Adjacent Property Owner. Also, be sure to complete the attached statement requiring / notarized signature. J 2) Complete short Environmental Assessment Fonn, /> Provide a recent (within 1 vear) survev of the property showing all existing and proposed structural improvements, including soundings done at low tide if you are proposing a structure out into the water. Your surveyor should be aware of the survey requirements set forth in local statute. ~ Provide a photograph of the site. 5) Applicable local statute empowers the Trustees to waive certain application requirements including (1) a description of the area from which removal or in which deposited material is proposed, or in which structures are to be erected, 2) two foot contour infonnation on a survey, and, 3) the necessity of obtaining all other required pennits and approvals (prior to submitting a complete application). All requests for a waiver of these requirements must be submitted to the Trustees in written fonn. 6) Submit one original plus 2 copies of the application fonn, appropriate Environmental Assessment Form, sketch, and 3 stamped surveys. 6) Payment ofrequired fee (See attached fee schedule). r; ,..... \~r;~ ~i 0° C TEST HOLE BY McDONALD GEOSCIENCE APRIL 1B, 2002 (EL. 12.6) DARK BROWN -,' SANDY LOAM BROWN "'0 SANDY LOAM "" -3' ... PALE BROWN FINE TO MEDIUM SAND -9' PALE BROWN SILTY SAND -11' PALE BROWN FINE TO MEDIUM SAND -14,9' (EL, -2.J) WATER IN PALE BROWN FINE TO MEDIUM SAND -21' o '0 "'I 01 ..-j K :Q o 1> \J ~ t.(¡ ~J.. ~ Q:;V (J AREA: 12,834 SF = 0.295 AC. 11£ LINE ALONG MEAN HIGH WA7E'R UNE ON APRIL 23, 2002. CERTIFIED TO: ROGER J. WALZ LESLIE WALZ SURVEY OF PART OF LOT 5 MAP OF GARDINERS BAY ESTATES, SECTION 2 SITUA TE AT EAST MARION TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK SCALE: 1 "=40' DATE: APRIL 23, 2002 S.C.T.M. DIST. 1000 SEC.03? BLK.06 LOT 005,00 1 EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF THE SURIÆY. GUARANTEES INOICATEO HEREON SHALL RUN ONLY TO THE PERSON(S) FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE TITLE COM- PANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTIONS LlSTEO HEREON, ANO TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE TO ADDmONAL INSTITUTIONS OR SUBSEQUENT OWNERS. THE OFFSE7'S (OR OIMENSIONS) SHOWN HEREON FROM THE STRUCTURES TO THE PROPERlY LINES ARE FOR A SPECIFIC PURPOSE AND USE AND THERE- FORE ARE NOT INTENOED TO GUIDE THE ERECTION OF FENCES, RETAINING WALLS, POOLS, PA nos. PLANTING AREAS. ADDmONS TO BUILDINGS AND ANY OTHER CONSTRUCTION. JOB NO. F3769 MAP NO. 275 FILED: SEPT. 23, 1927 REVISIONS: ~[ß?¿ Hcense no. 050149 Marc £. Charest, L.S. Successors to Canaliza, L.S. Robert A, Kart, L.S. Good Ground Surveyors, P.C. - . \ , . Albert J, Krupski, President James King. Vice-President Henry Smith Artie Foster Ken Poiiwoda Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~tal Erosion Permit Application _Wetland Permit Application _ Major _Waiver! Amendm~hangeS _Received Applicatjw1: #0 ¡- Received Fee:$ d (Y 1 Completed Application 1> Y{ 0 ~ _Incomplete _ SEQRA Classification: Type I_Type II_Unlisted_ _Coordination:(date se CAC Referral Sent: _Date ofInspection: !~ 0 _Receipt ofCAC Report: _Lead Agency Determination: _Technical Review: t ' / _Public Hearing Held: ~ .."y¡ 0 -ý Resolution: Minor r'-:--:--~r" n tJ If' !; i· '. -- MAY - 2 2O'Jl --'~-~.--- L;_: :~..~~) ;-~-~. - --_.- ---- .....-.-- .! :' Name of Applicant ~"3e4eJ .,. Le..slí~ tJ~/2.,. Address .1($ OS" OIJ... ()/t,dr....lt/Þ ~Ð ~sr rr)Rlt1o,{ NY Phone Number:( ) 477-0f.' , Nt 1/ i ,µ¡.. Phone: 417- C¡1S~ ~rJ-' V ~yµY' ])E51~i-¡JY t~v\/ Suffolk County Tax Map Number: 1000 - oj 1 - Iø - S- Property Location: o/þltÞIN£R ~ '13RY Ea.h-fe!J , J,,)bf (provide LILCO Pole #, distance to cross streets, and location) AGENT: Am,! /f)ItI'<TI",¡ / ÞA-iRwtA-11f~Je. _1V?own (Ifapplicable) / Address:.---11 :3 ---fP~ OÞ.e.r- , mAl'''' .sf. 'P.O' &,y; .52./ - : . Board of Trustees Application Land Area (in square feet): GENERAL DATA J 2., is 4- . Area Zoning: ¡( - Previous use of property: JW>tfle -h.m,''¡ /&5;¡(ent..t- Intended use of property: J"'"1/e.- ¡:~, ~ ¡f~fj ,,¡ en~~ Prior permits/approvals for site improvements: Agency Date 7~1r .,¡Jd 12M I f)Et. "øn JVæ'~'fJ¡Þr1 - AI'¡pI'I''n, c/ . t!>v, ì ti f;"r f).ep t _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspen~d by a governmental agency? V No Yes -- If yes, provide explanation: Project Description (use attachments if necessary): IJOD S~rw! .shJtey InlUnhWJ¿H1 ~ eOÞ;:; f; rJ'1 hDm 0(.....- _<4A'Y1~ -fo"f¡#i!.;" r --f!o entrOi.chmenf ~I tu/;fer13I'~ W¡'d;¡O¿~) · Board of Trustees Application WETLANDfIRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: -r~ WAL,.-Z€~ IJ-AtJe -R.eTl~dO fWD wiSH "-0 mß¡¿€ ~mmtL c'ð1T1t6€ ,/01"-- fZouAJD +tame WI"""" ?elÞAJD 6"ÍÞte1 Area of wetlands on lot: :y ~ (){)() ~ Percent coverage oflot: ,:f ðo % square feet Closest distance between nearest existing structure and upland edge of wetlands: J-/() , t: feet (/" t.,nf"II"') Closest distance between nearest proposed structure and upland edge of wetlands: tjot feet Does7he roject involve excavation or filling? No Yes 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: 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 of such proposed operations (use attachments if appropriate): n()n-t/ - .k~' dklf ¿f"",.t~ /pnAl/d~ ~ -!;!~.sr .f¡oø~ /J() ck"ýe .£ lJð~æ;~r' .l)teYRJ£2..¿$ ~ ~ rum'1l/ -n /", atlttle£ · Board of Trustees Application County of Suffolk State of New York IJm~ !lJ R-~ "í J 'J BEING DULY SWORN DEPOSES AFFIRMS THAT HElSHE IS THE APPLICANT FOR TIIE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO TIIE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TIllS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. TIIE APPLICANT AGREES TO HOLD TIIE TOWN OF SOUTHOLD AND TIIE 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 TIllS APPLICATION, I HEREBY AUTHORIZE TIIE TRUSTEES, TIIEIR AGENT(S) OR REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT TIIE PREMISES IN CONJUNCTION WITH REVIEW OF TIllS APPLICATION, Signature SWORN TO BEFORE ME THIS DAY OF ,20_ Notary Public . Town Hall . 53095 Route 25 P.O. Box 1179 Southold. New York 11971-0959 Albert J. Krupski, President James King. Vice-President Henry Smith Artie Foster Ken Poliwoda Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application _~f:-Mw~-------- C~~;~-~F SUFFOLK) ¿1 STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~ nJAA.i;;;u , residing at ~/f .s'l1-J¡-; being duly sworn, depose ~r,-r7 ff'jIIJtff- w... That on the /0 day property known as by placing the Board of easily be seen, and that I have checked to be has remained in place for eight days prior to ~liC hearin~. D~te of.h~ar~ng noted thereon ~ ~ tN. IJL. ~ '7 cJ f~ ¡un ed the it can poster Sworn to befo~A~=_ this day of , y~o 200~ ( ~- (;;LU~ ublic Dated: Sf..fz.- rrr:'»·;, i . ! í!,: ,.. -_~___?_." _' L . ~:,W:', 2GD2 Ie JOYCE M. WILKINS Notary Public. State of New York No. 4952246. Suffolk CoJ!nty Term Expires June 12, d-003 ~ / . / / Name,J~ PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: ~,57)~ f)µ O~ ~~ STATE OF NEW YORK COUNTY OF SUFFOLK ~~ , residing at 1...Ý18 ~ ~.¡-. tI.~~ V , being duly sworn, de oses and says tha on the :3 day of -?71 ¿~ ,~.;:( deponent mailed a true copy of the NoticeÆet 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 roll of the Town of Southold; that s d Notices were mailed at the United States Post Office at ~, that said Notices were mailed to each of said by (certified) (registered) mail. - --...... .._-....--. .-, c .,' 1 -, ) 1'-- ., Mm212G02 -~--- ~ -. '"\. ~. - JOYCE M. WILKINS Notary Public. Stat& of Naw York No. 4952246. Suffolk County Term Expires June 12. d-.óo ~ &rd of Trustees APPlicatiJP .'. AUTHORIZATION (where the applicant is not the owner) I, ~ ~:~property) residing at a d\j, J,..., 0f-' (~t;~l ~£sS,(¡J ð7'1:f2.- do hereby authorize Ary /YJWo/ (Agent) ;:/,u.~J1fI5:Jtt/ ~~ ~to apply for permit(s) from the Southold Board of Town Trustees on my behalf. "6. t. . ~ MAY 2 I 2!Jí)2 'c. 8 · NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: LJI=I z.., SCTM#1000- ~1 - ¡,-s- YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: PV'f' . A ~~CDrVO $T'Þtey A-bl:..T'O AS 01'\ .....me. +- ~'¡""'TløAls.- Nor C41A~6'~~ ~øc:IT Pt~'" ef" C¥.ISTl~r ~)mc 2. That the property which is the subject of Environmental Review.-is located adjacent to your property and is described as follows: d1S05' (QI J. Or&'....,..J., t:Rb 3. That the project which is subject to Environmental Review under Chapters 32, 37, or 97 of the Town Code is open to public comment on: You may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME:~" kr~ LA.1Jt...- MAILING ADDRESS' tIV"",,# ðúJ ~ Mtþ\AN\cl PaK~ N -.1 0'43"2.- PHONE It: to. -I.flf~ - 1QS6 Ene.: Copy of sketch or plan showing proposal for your convenience. s 1-4.16·4 (2187)- Tp-xt 12 I PROJECT 1.0, NUMBEn 617,21 Appendix C State Environmental Quality Review SHORTEN~RONMENTALASSESSMENTFORM For UNLISTED ACTIONS Only PART I-PROJECT INFORMATION (To be complered by Applicant or Project sponsor) 1. APPUCANT fSPONSOA 2. PROJEC7 NAME ,,.} W SEa 3. Municlpalltv LC> Cùunty 4. PRECISE LOCATION (Street aadress nd road intersections. prominent landmarks. etc.. or ~rovH::Ie map) j.506' OLl> DIU-HAre c:> 4<D 5. 1$ PROPOSED ACTION: o New 0 expansion 6. DESCRIBE PROJECT BRIEFLY: Moaificatlon/alteratlon ADO nO ~~IJO c..h £..n~C- STÐ~ to ~ -Ç'ødf" pr, n t ~!.TltJt; .s~/f.- -{'~:Lc..¡ hDm eo. ~~I(¡en Ce. of 7. AMOUNT OF LAND AFFECTED: Initially 0 acres UHimateJv 0 acres 3. ifilL!.. FRO?IJSEù ACTION CCMPL~ WITH 2XISTING ZONING OR OTHER EXISTING '.,AND USE :::!ESïr:tIC710NS? eYes C!?No If No. describe brleflv REQ'¡lltlSb 'z.e>III ~ t..uH.... - Non cøn~ m:-"', :SlOe. ,,/4.rd. -sc:r btu:J:.s. 9. '/J~~ ?RE5ENT LAND use: IN 'IIC¡NITY OF PROJECT? ~eSldent!a O.!naustrrat c: C.Jmmerclal Describe: o AgriCUlture i........! ParKIForesuOoen space L.! Other ,su..mmc..r ~ 'i eÞY - ro..,......t ~ L~,,\ I e.. -fA.-m:-L...¡ r-e. ~·l(lQnœ.s 10. DOES ACTION !NVOLVE A ?r:AMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (F~i)ERAL. STAT~ñ LOCAL)? g Yes 0 No If yes. !ist agency(s) and permitJapprovals 'ZÞA 8""I¿-. pee. ='c.1> .. nCln-JurL.sÞ'e.."'O~ ~~ \01 Ct>~-tou-=- 11. DOES ANY ASPECT F THE ACTlor~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes' 0 No It y~s. list agel"lcy name and permit/approval 12. AS A RESULT ~OPOSED ACTION WILL EXISTING PERMIT/APPROVAL AEOUIAE .'v10DIF!CATION? DYes ~No _. I CERTIFY THAT THE INFORMATION PROVIDED AeOve IS TRUE ,0 TH=: 3EST OF MY KNOWLEDGE Applicanllsponsor o",e'~ Slçnarure: If the action is in the Co"stal Area. and '{au are a state agency, complete the Coastal Assessment Form before proceeding with this a~~essment OVER ?Ari!" l1_SNVIF\O~!ME. 'SSëS3MENT ,-:-:J ~e c::r.-,:::;e~ac :'{ ..\ It les. ::::crOlnate :ne r!!\I"~'H :rocess ano 'Jsa ~ne =:...'L:" ::-A~ ¡ .:... JOE5 ..:.C7:C:-i :=':":C;;::='::::: :"'NY ,,:.:H,::. :-¡"¡::E5~GLJ IN'; .\i':'':¡::.¡::. :I:"'::.î j~ì.·:;::? :-,:':'~s I_:'\O 3. 'NILL .:..C7:CN .~E,:::'¡I¡Ë :::CACIN;.7c;:J .=lE'/lEW .....S ?P.C'IIOE:J ::.:;:1 'Jf'lL.S7S;) .:.G7;CNS iN 5 .'JyC:=:R. ;:.1,¡:;i '5~;-.57 :1 "~o. 3. .¡eça.c'¡e =o;C:.U::" may De suaersece.r; :.y :=.not:-:er ,n\lOI\lec1 açenC'I. L-: y~s C .'40 C. C::ULO ":"C7iCN .~E5UL:-:N ~NY :.ove;:;sc; ::====::·:75 ,J.SSCC:':' 720 ,vIiI..! -:...;=. .::'JL:_:wl~G. :AnS'Ners ;i'lCiY :e .,ancwrn:en. .f .eçICI~! C1. ::CLstlng air quality. :>urtace :lr grOl..:nowaler :::ualily .Jr :::t.:anmy, ,101se :e',eI5. .!Xls:Lng :.ai!ic ~at:erns. SOIlO .vas.e :lrcca.:c:;::n :)t :)Is:;:: ;:Iotentlal for o!ros,on, .:ratnaç;e or 'looClng :)rODlems? ~'{Dlaln ::merly: C2. ,J.estne!tc, ¡çric:,lItural. )(c:1aeoloqlcat, :'us::onc, Jr otner ,at~ta.1 :I( cUHural .·esourc~s: Jr ::Jmmunlty Jr "elçnccrnooo c:-::)rac:er? ~alan -' --... '/eo;elallon or :auna. :Jsn. :;roellflsn or ...,llallre scec:es, slgmiicanr :"IaCllats. :I( :hre31~ne<:l or ~nc:anç¡erea ~:::ec:es? Scclaln Jrlðrly: CJ., ..\ c.:::mmumt.,'S ðXlsIing ;'Ilans or ,;oals as offlc:aLly aQooted, or a cnange Ln use or intenSIty or use at lanc1 or other natural resources? S;(alaln ~r CS. Growtn, suoseQuent :::evelooment. éJ( relatec1 aC:lvltles likelY to :Je ,nClucea 'Jy !ne .:::rcposea a.c:lon? 2.....01:)ln .:metJv. ':5. !..cng :erm, ~nort :er:ï\. ;:,¡mUlòlive. Jr ·jtner ~11ec~s not .cenutied in C-:-<::S? :::C;JI<1¡n 'Jnerl.,. :!r.2~ -meac:s ¡nc:.,Jclnç¡ ::::-:anç;es In '.Ise at -a!tner quantity ·~r :vçe or ~nergy? ::"1;:)1';'1" :r;erl.,. J. 5 -j-!E~E,:A:S -:-¡...,E?;Ë :....:!Œ:.::- ';"0 5E. :~Nï¡:¡CVE?S" ~E!..Aï2:1:-0 ~IJTSNTI;"L .:.81J=-~S2 =;-VIRCNME~lï;'L .l.:Pð.C7S? _':'es _ ~o f ·:'es. ~xclaLn jt1eTlv ~ART III_DETERMINATION OF SiGNIFICANC~ ,To oe comoleteo oy -'''genc,1 INSïM.UC-:10NS; For e3C:1 adverse ~rfect idemifiea ~cove, aetermine wnetner it is substantial. large, ¡mcortant or otherwise signific :ac:l ~í1ec-: s~ould '::Je assessed in connection 'Nitn Its (a) setting ~i.e. urean or rural); (t;) ;:Irobaeility of occ~g; (cI duration: i(reverslbllity; (e geogracnic .3coce: anCl (f) magnitude. If necessary, aCId attac:öments or reference supporting materials. :':1sure :!xclanaticns ccntaln suttic:ent detail to snow that all ~e!e'/ant adverse impactS have been identifieCl ana adequatelY aCC:ressec. C;'ec!< ¡his box if :/QU have idemiiieo ene or ¡TIore ~oten[iaJy larçe or significant 2.G'Iersa imoac-::s whic:1 M.,4.::' oc":ur. ïhen ;Jroc~ea direc~ly to :h8 ~ULL =AF 3.naJor preoare a positive- declaration. C;'ecx. ~his ~ox ,t you have Cletermined, :Jased on the information and analysis above and any suocorti:;c dOC'.Jrnenta[lcn, :nat :he JrOOOS80 ac:íon I."JILL ~lOT result inJoy significant adverse env,rcnmenral ¡mcac~: ~NO .:Jrov1ce cn ;.\~ac:1r.1ents as nec~ssary, the reasons suçcorring rnls determination: .....,,'~ H .......u ....;~I'IC', ""11'11 Jr ~t:~ .....'np. .)1 -(~,,¡;;on\.OI~ "';lIlc~r .1'1 .........0 .....o:nC'1 :,110: 01 o{""oon\,OI~ ,jll,c~r ;.~n.lIU'~ " "¡'!~con~.o! ':1:,(.:'( ,1'1 ~.:'JO ,~.:.:,.,c., )I~nd:u'e " r'·..·.].1r~r :rr ":tr:I!·~.,t :ram '~~OO'HLOI~ oJ/Ilcn! ..).I(~ o . ~ APPLICANT TRANSACTIONAL DISCLOSURE FOnM The Town of S~u~hold's Code of ~bhic8 . rohibibs conflicbs ot nberesb on bhe parb of bown off cers and employees. The purpose of bhis form is to provide informabion which can alert the town of possible conflicts of inberest and allow ib bo bake whatever acbion is necessary to avoid same. ':'., '. "t': ;.I:"~: ~'i¡.5r.\'¡: ~ I "....¡'\·,~t,...f1'~.."I\.~."t'·· , . ."~,:. .' ,.\ "''''''~r' YOUR NAHEt Last name, first name. m dd~e 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.) . .. ;.: ,,~~~t. ::.:0., t:~':-:-;¡!!...:'.!~~~. NATURE O~ APPLICATIONs (Check all thab apply.) Tax grievance Variance Change of lIone Ap'p~~al of plat EX8~ption from plat or official map other (If "other," name the activity.) Do you persona1ly (or through your COMpany. spouse, sibling, parent, or child) have !I relationship vi\:h any officer or employee of the 'i'own of Southold1 "Relationehip" includes by blood, marriage, or business interest:. "uusiness in\:erest:" Means a business, including a partnership. in vhich t:he tovn officer or employee has even a par~lal ovnership of (or employment by) a corp.oraHon tn which the tovn of[icer or7m loyee ovns more than 5% of the shares. ~:.:y .' YES NO ,to "~J0 Lv '- t;~.n~ . If you answered Ø~BS,", complete t:he balance of ~biø form and da\:e aDd sign where indicated. Name of person employed by the Town of Sout:hold Title or position of that person Describe the relationship between yourself (bhe applicant) and the town officer Qr employee. Eibher check the appropriate line ~) through D) and/or des~ribe in the space provided. The town officer or employee or his or her SpoUSSi 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 BPplicånt (when the applicant is a corporation)/ B) the legal or beneficial owner of any interelt in a noncorporate'entity (when the applicant is not a corporation), C) an officer. director. p~rtner, or emplöyee ot the applicant/ or D) ~he ~ptual applicant. , .' . . . . .)~~.r· .. ... DESCRIPTION OF nELATloNSIIIP ". . . '. ~ . ...,. ." ~ , w .. . , ... t· ~. . I,' . I· ., ; ,.. .'... "..,._ ~".":.1·...... A.....r..¡· ...~:,~.. ;;:Jf:.' sublnibt:.ed Sigh&tIJre 'pdnt ...-..-" , ' . <:·t~œr