HomeMy WebLinkAboutTR-5727Board Of $outhold Town Trustees
SOUTHOLD, NEW YORK
ISSUED TO ..................... LA~.R.~...$.I~.Y~ g..~1 ...................................
Pursuant to the provisions of Chapter 615 of the Laws of
the State of New York, 1893; and Chapter ~ 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 . .~]~. ~.,
207~, and in consideration of the sum of $. ?-00..00 .... paid by
Suffolk Environmenta~ ~9n~j~l~z~g.,. In~,....0r~..behalf...o£ .......
ct ..... Bridg. eham.~ton., .NY .. N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following:
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, and these presents to
be subscribed by a majority of the said Board as of this date.
r ~~
TERk4S and CONDITIONS
Tl~ ~ Larry Save2in~ ,
parc of the consider~doa ~oc the ismtnce o~ me 1'~,¢ aoe~ un~zcana aha ptescxz~ to the roi-
with meslaect thereto, lo ~e complete ,-r~,egon oE the Bo~d o~ T~e~.~_ a~d~e Town a~ ,Saa~bo~
2. ThatthisPezmltis'valld~:ape~odof 24 mos. which h ~ to be the
esthnated time' ~luh~d eo complete the work involv~t, but sh~l_d cizcum~_ _,~s wamu~ mtuest
for sn ~ n may be m~de to the Boztd st s lm~ d~.
~. 'Is~at t~s Pev~t should be ve~d indd'mitely, o~ as long as the said p~vloee wt.s~es
to maintain the stmct~e or project involved, to provide evidence to anyone concerned that auth-
orization wzs otisimll~ obtained.
4. That the wodc involved ssfill be subject to the ~ and approval of
it~ agents, and non..con~lignce xvith the p£ovi~olx~ of the otlg[n~g Itppl~catlon, m~y
xevocation of this Permit by x'~=,olution of the said Boa~cL
5. That fl~ere will be no unreasonable interference ~ navigation as · result of the
herein
6. That there ~hall be no intederence with the tight of the pui~c to ~ and repass Idaag
the bea~ between Mgh ~mi low wa~er m~k~.
7. That tf future opetatim~s of the Town of 5outhold xequ~e the xemoval and/or ahexafiozs
~n the locat/on of the wodc herein au~ or ii, htt~oplnk~oidse~oaxdofT~,~es, thC
work d,,l~ arose unr~sonable obstmcuon to free navig~i~o, the said Pennlttee ~ be m~lted~
upon due notice, to ~-cmove ot alter d~s work ot project herein stt~d without ~ to th~ Town
8. 'I'b~ the said Board will bc m:~fied by the Pexmittee ot d~ ,'m'n.~:giOa'O~ dsc x~x'k ~
ot-ked.
9. That the permittee will ~ aH other permits and consents dzat mty I~e zequh'ed
pfemental to this permit w~'_u~ may be subject to revoke upon faiiute to ~ same.
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
March 25, 2003
Mr. Bruce Anderson
Suffolk Environmental Consulting, Inc.
PO Box 2003
Bridgehampton, Nh' 11932
RE: SCTM#53-01-14
Larry Severini
1795 Pipes Neck Road
Greenport, Nh'
Dear Mr. Anderson:
The Board of Town Trustees took the following action during a Regular Meeting, held on March
! 8th, 2003 regarding the above matter.
WHEREAS, Suffolk Environmental Consulting, Inc. on behalf of Lart3, Severini applied to
the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the
Town of Southold, application dated December 27, 2002.
WHEREAS, said application was referred to the Southold Town Conservation Advisory Council
for their findings and recommendations, and
WHEREAS, a Public Heating was held by the Town Trustees with respect to said application on
March 18th, 2003 at xvhich time all interested persons were given an opportunity to be heard, and,
WHEREAS, the Board members have personally viewed and are familiar ~vith 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 xvith the standard set forth in Chapter 97-18 of the Southold
Town Code.
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 approved the application of Suffolk Environmental
Consulting, Inc. on behalf of LARRY SEVERINI request a Wetland Permit to construct a 975
sq, fi, +/- addition to the existing dwelling; a 250 sq. fi +/- attached porch a 187 sq, fl, +/- rear
deck]patio addition to the existing rear deck/patio; and a 500 sq. fl. 4¥- detached garage ~ per
approved plans dated and stamped March 18, 2003.
BE IT FURTHER RESOLVED that this determination should not be considered a determination
made for any other Department or Agency, which may also have an application pending for the
same or similar project.
Fee must be paid, if applicable and pemfit issued within six months of the date of this
notification.
If inspections are required, at a fee of $5.00 per inspection (See attached schedule).
FEES: $5.00
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/cjc
cc DEC
Building Depamnent
Suffolk Environmental Consulting, Inc.
Ncwmztn Village. Mare Street. I~C). Bt}', 2003. Bridl:ehumpron. Ncx~ h't~t'k
Bruce Anderson. M.S.. Pre,idem ; -
May 7, 2003
Town of Southold Board of Trustees
Town Hall
53095 Main Road
P.O. Box 1179
Southold, NY 11971
MAY -9
Re:
Situate:
SCTM #:
SEVERINI property
1795 Pipes Neck Road
Greenport; Town of Southold, NY
1000-053-01-014
To whom it may concern,
As per your request, please find enclosed herewith:
Check in the amount of $ 5.00 in order to cover
the additional permit application fee.
Kindly issue the requested permit at your earliest opportunity. Should you have an>'
questions concerning this matter, please feel fi'ce to contact this office at any time. Thank
you in advance for your consideration and attention.
Sincerely,
Matt D. [vans
enc.
Albert J. Krupski, Preside~I~
James ICing, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
§3095 Main Road
P.O. Box 1179
Southold, New York 11971
Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
· 0: Suffolk En. vironmental Consul%~.ng Inc., on behalf of Larry Severini
Please be advised that your application, dated December 27, 2002
has been reviewed by this Board, at the regular meeting of
Marck f~, 2993 and the following action was taken:
( X) 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:
One Inspection @$5.00
TOTAL FEES DUE: $
SIGNED:
BY:
PRESIDENT, BOARD OF TRUSTEES
;LERK, BOARD USTEES
4/98
Albert J. Krupski. Preside~
James I<Ang, Vice-Presidew
Artie Fester
Ken Poliwoda
Peggy A. Dickerson
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town }iai!
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
LARRY SEVERINI
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE 8OARD 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
X
Pre-construction, hay bale line
__ 1st day of construction
½ constructed
Project complete, compliance inspection.
Albert J. Krupski, Presiden~
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
1st day of construction
¼ constructed
v'/ Project complete, compliance inspection.
Suffolk Environmental Consulting, Inc.
NCWIIKil] \llla_c. M,lm _Street. P.(). B.x 2 )~ Btid?hamptt n. Ncx~ Y,,rk 11~2 2<~g
Bruce Anderson. M.S.. Pre,.ident
Via Telecopier and Regular Mail
January 21, 2003
Southold Town Trustees
Albert J. Krupski, President
P.O. Box 1179
Southold, NY 11971-0950
Rez
Severini
Situate: Pipes Neck Road, Southold
SCTM# 1000-53-1-14
J~ 2 'L/'&m3
Dear Mr. Krupski:
This Firm represents Mr. and Mrs. Severini who own the property referenced
above. We filed an application for wetlands permit and the public hearing is to be held on
January. 22, 2002.
Kindly adjourn this matter until the next regularly scheduled hearing date. Our
request for adjournment relate to certain modifications to the survey before you.
Yours tr ly~
Brace A. Anderson
cc. L. Severini
STROUGH REAL ESTATE 681-537-5198
Suffolk Environmental Consulting, Inc.
Bruce Andt, rson. M.S, Picqdcnl
Via Telecopier and Re/!lular Mail
January. 21, 2003
Southold Town Trustees
Albe~] J Krupski, President
PO [toxll7g
Southold. NY 11971-0950
Re
Severini
Situate. Pges Neck Road, Southold
SCTM# 1000-53-I-14
Dear Mr Krupski'
This Firm represents Mr. and Mrs Severini who own the property referenced
above We filed an application for wetlands permit and the public hearing is to be held on
January 22, 2002
Kindly adjourn this matter until the next regularly scheduled hearing date. Our
request tbr adjournment relate to certain modifications to the survey betbre you.
· -7 Yourstr ly, ~/r?~.....___~~
Bruce A Anderson
cc L. Severini
Telephone
(631) 765-1892
Town H'a, ll, 53095 Main Road
P,O. Box 1179
Southold. Ne,~ York 11971
SOUTItOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Wednesday,
January 15, 2003, the following recommendation was made:
LARRY SEVERINI to censtruct a 975 sf. addition to the existing dwelling; a 256 sr.
attached porch; a 187 sr. rear deck/patio addition to the existing rear deck/patio; and a
500 sr. detached garage.
Located: 1795 Pipes Neck Rd., Greenport. SCTM#53-1-14
The CAC did not make an inspection, therefore no recommendation was made.
Suffolk Environmental Consulting, Inc.
~ _00:,. Bridgchainpttm. Ne~.,.
Ne'.', than Villa,_,c. Nl~.m~ Street. P.O. Box"
1~531 ~ 537 5 I('~O i-'a\: t6311 53.7 519";
Bruce Audersuu. M.N.. President
December 23, 2002
Mr. Albert J. Krupski, President
Town Hall
53095 Main Road
P.O. Box 1179
Southold, NY 11971
13F 2
Re:
Situate:
SCTM #:
Severini property
1795 Pipes Neck Road
Greenport; Town of Southold, NY
1000-053-01~014
Dear Mr. Krupski,
This Firm represents Mr. Severini who is seeking improvements to the above referenced
property. In order to do so, a Wetland Permit from your Board is required. Enclosed
herewith please find a completed Wetland Permit Application. Application contents are as
follows:
(1) Town of Southold Trustees Wetlands Permit Application;
(2) Short Environmental Assessment Form;
(3) Location Map of subject property (two [2] copies);
(4) Survey of the property, prepared by Joseph A. Ingegno. L.S.
indicating both existing and proposed structures (two [2] copies); and
(5) Check made payable to the Town of Southold in the amount of $200.00
covering the requisite application fee.
Hammartlg 2
By way of this correspondence, and on behalf of Mr. Severini, I request that you
commence review of this application. Should you have any questions or require additional
information, please feel flee to contact this office at any time. Thank you in advance for
your cooperation.
Matt D, lvans '-
el'lc.
cc: L. Severini
SEVERINI Pro er
Situate: 1795 Pipes Neck Road; Greenport; Town of Southold, NY
SITE
PIPES COVE
HAGSTROM StreetAtlas
SCTM#: 1000-053-01.014
Albert J. Krupski, President
John Holzapfel. Vice President
Jim King
Martin H. Garrell
Peter Wenczel
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Town Hall
53005 Main Road
P. O. Box 1179
Southold, New York 11971
Telephone (631 ) 765-1802
Fax (631) 765-1823
Office Use only
Coastal Erosion Permit Application
X Wetland Permit Application
Grandfather Permit Application
Waiver/~m~endmenr~Cha~es
Received Applicat~on:i~/D
Received Fee: $ ~9~ -' ;-.1 ! /
__Completed Application
Incomplete
SEQRA Classification:
Type I Type II Unlisted
Coordination: Idate segt)~
CAC Referral Sent::
Date of Inspection:
Receipt of CAC Report:' I
Lead Agency Determination:
Technical Review:/ ~ -
Resolution:
Name of Applicant Larr~ Severini
Address 5 Hillcrest Court; Old Ta~an,
Phone Number( 201 ) 784 5611
NJ 07675
Suffolk County Tax Map Number:
Property Location:
provide LILC0 Pole
AGENT: Suffolk Environmental Consultin~
Address: P.O. Box 2003 Brid~eh~un~ton,
Phone Number: (631) 537-5160 Fax: (631)
1000-053-01-014
1795 Pi~es Neck Road, Green~ort, NY
#, distance to cross streets, and location2
1
Board of Trustees Application
Land Arealin square
Area Zoning:
Previous use of property
Intended use of property:
GENERAL DATA
feet): 14, 375 square feet
Private single family dwelling
Private residential dwelling with
proposed additions/appurtenances.
Prior permits/approvals for site
knowledge
Agency
improvements: None to our
Date
X No prior permits/approvals for site improvements.
Has any permit/approval
governmental agency?
ever been revoked or suspended by a
X No Yes
If yes, provide explanation:
~roject Description (use attachments if necessary) :
Applicant proposes to construct a 975 sq. fl. ± addition to the existing
dwelling; a 256 sq. ft. ± attached porch; a 187 sq. ft. ± rear deck/patio
addition to the existing rear deck/patio; and a 500 sq. ft. ± detached garage.
of Trustees Applicatio--n
WETL/~D/TRUSTEE L/~NDS APPLICATION DATA
Purpose of the proposed operations:
Applicant proposes to construct a 9?5 sq. ft. :t: addition to the existing
dwelling; a 256 sq. fl. ± attached porch; a 187 sq. fl. + rear deck/patio
addition to the existing rear deck/patio; and a 500 sq. fl. + detached garage.
Area of wetlands on lot: 0.0 ± square feet
Percent coverage of lot: 0.0 ± %
Closest distance between nearest existing structure and upland
edge of wetlands: > 80.0' ± feet
Closest distance between nearest proposed structure and upland
edge of wetlands: > 80.0' ± feet
Does the project involve excavation or filling:
X No Yes ,, ~
If yes, how much material will be excavated? N/A
cubic yards
How much material will be filled? N/A · cubic yards
Depth of which material will be removed/deposited: N/A ± feet
Proposed slope throughout the area of operations: N/A ±
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):
No in~act to the wetlanc~s are anticipated due to the pro~ect clesi~/n and
location, specifically the positionin~ of the proposed addition, porch,
deck/patio and ~ara~e to maximize all associated setbacks from the
wetlands located conti~uous to subject pro~ert~. In addition, the existinq
dwellin~ has had no negative in~oact on the wetlands.
Purpose of
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Proposed Activity:
N/A
present within
Yes
Are wetlands
No
If Yes, how much material will be
How much material will be filled?
75 feet of the proposed activity?
excavated?
(cubic yards)
(cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts
reasonably anticipated resultin9 from the implementation of the
project as proposed. (Use attachments if necessary)
NOTICE TO ADJACENT PROPERTY OWNER
B~m~RD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
Larr~ Severini
SCTM#: 1000-053-01-014
YOU A/{E HEREBY GIVEN NOTICE:
1. That is the intention of the undersigned to request a Permit
from the Board of Trustees to:
Applicant proposes to construct a 975 sq. ft. · addition to the existing
dwelling; a 256 sq. ft. ± attached porch; a 187 sq. ft. + rear deck/patio
addition to the existing rear deck/patio; and a 500 sq. ft. + detached garage.
2. That the property which is the subject of Environmental
Review is located adjacent to your property and is described as
follows:
1795 Pipes Neck Road; Greenport; Town of Southold, NY
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. 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:
MAILING ADDRESS:
Larry Severini
P.O. Box 334; Wading Riverr NY 11792
PHONE # : (201)784-5611
Enc.: Copy of sketch or plan showing proposal for your
convenience.
Name:
Ignatia Foti
Carla A. Carroll
Jean Eckardt
Milazzo Family, LLC
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Address:
324 East Westiew Avenue
Leonia, NJ 07605-1812
32 Brockmeyer Drive
Massapequa, NY 11758-7803
11Stuyvesant Oval, Apt. 10G
New York, NY 10009-2006
137 Kings Highway
Hauppauge, NY 11788-4203
STATE OF NEW YORK
COUNTY OF NEW YORK
I, Diane Wassick, residing at Suffolk Environmental Consulting,
Inc.; Newman Village; Main Street; Bridgeham~ton, NY, being
duly sworn deposes and says that on the 23rd day of
December, 2002, deponent mailed a true copy of the Nothce set
forth in the Board of Trustees Application, directed to each of
the above named persons at the addresses set opposite their
respective names; that the addresses set opposite the names of
said persons are Ehe address of said persons as shown on the
current assessment roll of the Town of Southold; that said
Notices were mailed at the United States Post Office at
Bridgehampton, that said Notices were mailed to each of said
persons by (certified) (registered) mail.
Sworn to before me this
day of _,~j~-~ , 2002_
// Notary Publi~
Notary put~lm ot NeW
No. ~ W6053859
6
Board of Trustees ApplicaEion
County of Suffolk
StaTe of New York
Diane K. Wassick, BEING DULY SWORN DEPOSES AND AFFIRMS THAT
HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND
THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF
HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN
THE MA~NNER SET FORTH IN THIS APPLICATION A/~D AS MAY BE APPROVED
BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES
TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HA/~MLESS AND
FREE FROM ANY AND ALL DAMAGES AND CLAIMS A_RISING UNDER OR BY
VIRTUE OF SAID PERMIT(S), IF G~tNTED. 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.
Diane K. Wassick
SWORN BEFORE ME THIS
/~-a r y Public
DAY OF ~c 2002
Matthew D. Ivans
Notary P[~Uhc of New Yor~
No. 011V6053859
Qualifie~ in Suflolk County .o
Commission Expires January 22, 2~°~
7
OWNER'S ENDORSEMENT
(TO BE SIGNED IF APPLICANT IS NO'[ OWNER)
51'A t E OF NE~,k,'tORK)
COUN I'Y OF SUI, [:OLK)bb."~'-
L.arr~' Se~ erini being duh.' s~ om, deposes and Sd)s; ! reside at
5 Hillcresl Couri; Old Japp~ N [ 07675
Ill Ihe County of New York and the state of New York__
and [' am the (owner in fee) (officer of th(, Corporation ~ hich is owner in tree) of
the premises described in the foregoing application and lhat 1 have authorized
~!t. llvi~ l:'nPtrontnental L'onsttltitt~ lttc.
to make the Ioregoing application as described herein.
Signatm'e
Iff'orpotatmn, name of cm'poration,md Oflker
Eetore me, thiq ~
d~IV of
Ofl'icer'~ Title
14-16-4 (g/95)-Text 12
I PROJECTI.D NUMBER
617.20
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
SEQR
PART 1- PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
[. APPLICANT/SPONSOR '~. PROJECT NAME
Suffolk Environmental Consulting. Inc. SEVERINI
3. PROJECT LOCATION:
Municipality Southold County Stl~ol~
4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc. or provide map)
1795 Pipes Neck Road: Greenport. NY
5. IS PROPOSED ACTION:
[] New [] Expansion [] Modification/alteration
6. DESCRIBE PROJECT BRIEFLY:
Applicant proposes to construct a 975 sq. ft. + addition to the existing dwelling; a 256 sq. ft. +
attached porch; a 187 sq. ft. ± rear deck/patio addition to the existing rear deck/patio; and a 500
sq. ft. ± detached garage
7. AMOUNT OF LAND EFFECTED:
Initially < 0.1 acres Ultimately < 0. I acres
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 ~]lndustrial [~Commercial ~]Agficulture
Describe:
[] ParkJForest/Open space J--IOther
Prix ate single fanfily residences with related appurtenances.
I¢). DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT
AGENCY (FEDERAL, STATE OR LOCAL)?
[] Yes ~]No If yes, list agency(s) and permit/approvals
NYSDEC Wetlands approval: SCDHS approval.
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No If yes, list agency(s) and permit/approvals
]2. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REOUIRE MODIFICATION? [] YeJ [] No
I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor name: ..~tI D.. ,1¥9~ ..?/~olk Enx~onmental Consulting, Inc. Date: 12/23/02
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
SEVERINI Pro er
Situate: 1795 Pipes Neck Road; Greenport; Town of Southold, NY
SITE
HAGSTI?OM StreetAtlas
SCTM #: 1000 - 053 - 01 - 014
o~- ~
12°3
D£~D