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Home My WebLink AboutTR-5196Alber~ J. Krupski, President James K~ng, Vice-President Henry Smith .-~'t ie Foster ,,Zen Po[iv.'~c,,l Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-} 892 Fax (631) 765-136~ Fuoraary~,2001 BOARD OFTOWNTRUSTEES TOWN OPSOUTHCLD Mr. Jeffrey T. Butler, P.E. 29 Overhill Road P.O Box 63'4 S;:oreham, NY ! 1786 Re: Ma2NZI HOMES i0505 So,;ndv!ew Ave., Southold .%CTM#54-5-37.2 Dear Mr. Butler: The follmving action was taken at the Southold Town Board of Trustees meeting held on Wednesc. ay, Febr Jar¢. ~. ~ . '*0~.., · _ ~' RESOLVED, rt,~.t m'~ Svu t,.otd ~o~u B,.,ard ot l'rustees Approve the request tbr an )wnendmem to Pena~L ~5196 for :.~ n¢,.v 3:ugle-famfly dwelling, deck, garage, and septic system, and 55' nou- d[sturbanc.zbah,,r,' ~"- '~., ~,¢ .... aaw plans last revised February 20, 2001. This is not a determi.'.:ation from any other agenc}. If you have any questions, please call our office at (63l~ '~65-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:lms Bldg. Dept. NORTH FORK rNVlRONId£NTAL COUNCIL, INC. Rt. 25 at Love Lane, PO Box 799, MattitucR, NY 11952 Tel.: 631-298-8880 Fax: 631-298-4649 nfecl@aol.com www.lieast.corn/n~ec February 21, 2001 Southold Town Board of Trustees Southold Town Hall PO. Box 1179 Southold, New York 11971 Gentlemen, I am writing to express my concern about the "Manzi Homes" application for an amended permit on property located 1050 Soundview Avenue, Southold. Since originally applying for a wetlands permit, the principal has increased the footprint of the proposed dwelling by almost 400 feet and has moved the structure 10 feet closer to the wetland delineation line. Since the original permit was granted by the Southold Town Trustees, the Southold Town Board has adopted legislation which increased the jurisdiction of the Trustees from 75 to 100 feet, thus giving added protection to the wetlands throughout the Town. In light of the recent adoption of this local law, I urge the Board to require that the applicant adhere to the specifications of the original permit. The proposed dwelling is significantly larger than the surrounding homes and the applicant has the ootion of s~ing down the scope of the project. As a second option, the applicant could m~ve the duelling closer to the road and go before the Board of Appeals for a front yard setback variance. From our perspective, moving the dwelling closer to the road as opposed to closer to the wetlands is a more environmentally sound option. This particular area has environmental significance. It is connected to the Peconic Dune system and is part of the fresh water wetland system that runs from Great Pond to Lily Pond. It is the responsibility of the Trustees to examine this application with the utmost care. On behalf of North Fork Environmental Council, I urge the Broad to exercise their authority and den5' the amendment to the permit as requested be the applicant. Thank you for your consideration. Respectfully, Southold Coordinator a non-profit organization for the preservation of land, sea, air and qualiW of life printed on ~'~ recycled paper ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and ~ive to Town Clerk's Office (agency Freedom of Information Officer).~ One copy will' be returned to you in response to your request, or as an interim response. SECTION I. TO: ~) l.~ ,~. ~_~--~ (Department b~r Officer, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.) Signature of Applicant: Printed Name: /~/ ~/~/~+~z-~ Address: ~f~/~ ~ ~.~ Maili,g Address (if different from above): [ ] APPROVED · I~ C I~ I VIE D [ ] APPROVED WITH DELAY* [ ] DENIED* Eta~abeth A. Neville Freedom of Information Officer FEB ! 5 .001 Clerk * If delayed or denied see reverse side for explanation. ~lepho-e 531) 765-1892 Tow~ Hall. 53095 Main Road P.O. Box 1~."/9 Southold. New York 1197]. SOUl?HOLD TO~N 'COiNSERVA.TIO[~ ADVISORY COIJbICIL At the meeting of the Southold Town Conservation Advisory Council held Thursday, February 15, 2001, the following recommendation was made: MANZl HOMES 54-5-37.2 to Amend Permit #5196 for a new single-family dwelling, deck, garage, and Septic system. 10505 Soundview Ave., Southold The CAC did not make an inspection, therefore no recommendation was made. 21 February 200l From IMaryanne Murtaugh, 10400 Soundview Avenue, Southold, NY l 1971 Remarks to Southold Board of Trustees, Southold Town Hall, Southold, NY 11971 Re: Amendment to Wetlands Permit # 5196 requested by Manzi Homes of Rocl%, Point, NY. l'he Soundview Ave Wetlands (SVA) are small and fragile and already stressed by years of Road Runoff down the Hickory Lane Culvert and from the surrounding development most of which predates the enactment of NYS Article 24. This special FWWL is unique to Long Island and especially to Eastern Suffolk County as demonstrated by the 1988 Sanford Report to the NYS- DEC. The SVA Wetlands are providing a valuable microenvironment that affords protection, water, breednig and nesting grounds for numerous mammals, amphibians, birds and insects as well as important obligate wetland grasses, ferns and bushes. Being on an island such as Long Island, extirpation can occur more easily with any of these species -- and many animal and plant species here are already threatened and rare. Great care is needed to protect what is fragile in our immediate environment now. The SVA Wetlands are linked by hydrology to both Great Pond and Lily Pond and they form a continuum of small wetlands behind the Eastern edge of the Peconic Dunes. For these important reasons, I ask you to take a very close look at the Manzi Homes Permit request: 1 ) Given the Importance and Uniqueness of the SVA Wetland to both Southold and Suflblk County -- a Full SEQR Review' should be undertaken. These Wetlands and the Swale on their North side should seriously be considered as a whole for special Preserve Status. Wetland permits should only be considered when strong and appropriate protections are in place. 2) Regarding the "Amendment Process"-- There is no statement codified in Chapter 97 on "Wetlands"in the Southold Town Code that allows for the addition of an "Amendment" to an existing Permit. Without an .Amendment Clause in the Code, extensively changed Site Plans should require a NEW PERMIT Tire Manzi Pemfit in particular .... 3) Contour/Elevation Value Discrepanciys: There is no correspondence in elevation values at defined landmarks when the original and current Mat~zi Site Maps are compare .~-,~ Original Current Prizeman l 1- IT 9-10' -6' (below 8') Vegetation Line Water Line 10-1 l' 8-9' Prizeman Septic Sys. 14' 12' Haybales 14' 1 l' 10-IT 4) Mai~zi septic system is only 70' from the Vegetation Line. This should be increased.~o :~-~, ?3 . ?.o-/.7,-----.~,'. ~i" ..... 5l The house is too big for the plot at - 2500 square feet. 6) Maximum Tree Clearance should be stipulated at 35% within the Building Envelope. 7) Runoff should be confined to the the Property and so stipulated 8) Permanent Nondisturbance Buffer should be mandated at a minimum of 50' following the contour of the Wetland itself. 9) No Clear cutting of any trees or phragmites within the Nondisturbance buffer should be allo~ved and strictly enforced. 10) Proposed Well is only 135' from my Septic System across the street -- not 150' as shown on the Manzi Site Plan. Board Of Southold Town Trustees PERMIT NO.. SOUTHOLD, NEW YORK ~/lJJ~j~ DATE: ,.. ~.~y ..1~.,.;~0. 0 MANZI HOMES, INC. ISSUED TO ....................................................................... ." 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 ."REOULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL' OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:,'.:.' and in accordance with the Resolution of The Board adopted at a meeting held on .~]~...,~ ........ 19 ..~.9.9.g and in consideration of the sum of $...15Q...Q0 ..... pald by Man.~. Hor0.~.~... Inc ............................................... : ..................... of ....gg.~....~P!7~.,. .................... ; ........................ N. Y. and subject to the Terms and Condlflons hsfed on the reverse side hereof, · of Soufhold Town Trustees authorizes and permlfs the followlng: Wetland Permit for a one (1) family dwelling, deck in rear, septic and cesspool 75' area. 'With haybales 20' from corner of deck and house, left in place permanently. Which gives them a 55' non-disthrbance buffer. all in accordance with the detai~ed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate. S.e. al to. be affixed, and these p.resents to be subscribed by amalor,ty ct the smd Board as of th~s date. ¥-. _ Attic Foster ~absent) -- - T~ustcet TERMS and CONDmONS The Pe~mk~ce Manzi.Homes, Inx. residing ac 1 2 M,~r~,~ ~$v~,~$. ~,~L-y 1~!~+_. bi. Y, ts part of the consideration for the issuance of the Permit doe~ undetstnnd and pzesct~ to the fol- lowing: '1. That the sa~d Board of Trustees and the Town of ~outhold are released from any and aU chm~ges, or ~t-i,~ for cl~es~ of suits arising cl~ecdy o~ indirecdy ss a result of any oper- ation pedonnod pursuant to this p~...'t, tad the said P~,~d~ee will, at bis ot bet own defend any and tH such mits'initiated by tbttd patties, and the said Petm~ttee assumes ~ with respect thereto, to the complete exclusion of the Boaed of Tmstces of the Town of 2. That this'Permle h'vaild for a ~tiod of 2,4 mos. which is conddmsi to be the estimated time' tequlted m complete the wo~ involved, but should circumstances warrant, request for an extension may be made to the Boxrd at a later date~ 3. That this Petit should be tetainod indefinitely, or as long as the said Pemtktee withe~ m maintain the structure or pwject involved, to provide evidence to anyone concerned that anth- orlzadon was orig~nally obtained. 4. That the work involved will be subject to the inspection and approval of the Board ot its agents, and non-compliance with the pt6visiom of the otlginatlng appllcafion, may be cause for tevocatlon of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with n~vigation as m remit of the work herein authorized. 6. That there shall be no interference with the right of the [~blic to [ra~ and repass *long' the beach between high and low water m~e]cso 7. That if future operations of the Town of Southold requite the removal and/or alteratiom in the location of the work herein anthotlzed, or if, in the opinion of the Board of Tmstee~ the. work shah cause unreasonable obstruction to free navigation, the said Petmktee will be t~luited, upon due notice, to remove or alter this work ot project herein stated without expenses to the Town of Southold. 8. That the said Board wiH be notified by the Permlttee ot the co~letion of the work anth- orlzed. 9. That the Petmittee will obtain aU other permits and consents d~t may be requited plemental co this permit which may be subject to t'evoke upon failuce to obtain same. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda 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 July 20, 2000 Mr. John Guido c/o Manzi Homes Inc. 12 Monroe Street Rocky Point, NY 11775. RE: SCTM#54-05-37.2 10505 Soundview Avenue Southold, NY Dear Mr. Guido: The following action was taken by the Board of Town Trustees during a Regular Meeting, held on July 19, 2000, regarding the above matter. WHEREAS, MANZI HOMES, INC. applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of $outhold, application dated June 29, 2000, 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 July 19, 2000 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, 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 application for a one (1) family dwelling, deck in rear, septiC and cesspool 75' area. with haybales 20' from corner of deck and house, left in place permanently- Which gives then a 55' non-disturbance buffer. 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. Permit to construct and complete Rro~ect wi~lll expire two year~ from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None Very truly yours, Albert J.&'Krupski' Jr. President, Board of Trustees AJK/cjc cc: DEC ACE Dept. of State Telephone (516~ 765-18~2. Town 'Hall. 53095 ~ R~ad P.O. Box 11/9 3ou~old, New. York 11971 $OUTHOLD TOWN CONSERVATION ADVI,$ORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, July 11, 2000, the following recommendation was made: Moved by Richard Smith, seconded by Scott Hilary, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit Application of MANZI HOMES 54-5-37.2 to construct a single family dwelling with deck, septic and cesspool. 10505 Soundview Ave., Southold The CAC recommends Approval with the Condition ora 50' non-disturbance buffer and no clearing from approved wetland boundary line. There should be hay bales at 50' and no clearing for a view. Vote of Council: Ayes: All Motion Carried ELIZABETH A. NEVILLE TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (516) 765-1823 Telephone (516) 765-1800 OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD APPLICATION FOR PUBLIC ACCESS TO RECORDS INSTRUCTIONS: Please complete Section I of this form and give to Town Clerk's Office (agency Freedom of Information Officer). One copy will be returned to you in response to your request, or as an interim response. SECTION I. TO: ~'~r~c(~ ~J-~ ~ (Department or Off|cer, if known, that has the information you are requesting.) RECORD YOU WISH TO INSPECT: (Descr:ibe the record sought. If possible, supply date, file title, tax map number, and any other pertinent information.) Signature of Applicant. [/J~o/,t~E~,,~ l/I/J Printed Name: IvlC[V~n.,~ ,^ ~e-. l~,;~--'~.~- ~ eailing Address Jif different from above): Telephone aum e : :- [ ] APPROVED aI~CalVED [ ] APPROVED WITH DELAY* [ ] DENIED* Elizabeth A. Neville Freeaom of Information Officer JUL I 8 2000 )c, uThOId Iod)Jl~lerk * If delayed or denied see reverse side for explanation. J J :lj¥' OIOHIIIO~ .~0 N/AOJ. $:1:11511B1 ~0 0~1¥0i~ Alt O:lAOBdd¥ 0 Town Tr~tees P.O Box 1179 Southold, NY 11971 MANZI HOMES, INC P.O BOX 702 ROCKYPOINT, NY 11778 7x~x~ 1039 FAX: 7x.~ 0032 December 12a, 2001 lh~ar, linoo permit # 5196 Property, Soundview Ave, Southold. EC; 9 To whom it may concern This letter ia to notify you that the house on Soundview Ave. in Southold permit ~ 5196 has been completed and ia ready for a final inspection. ffyou have any questions please contact me ~ (631) 744-1039. Thank ygu ~ Manzi Homes, Inc Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Po!iwoda BOARD OF TOWN T~USTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 LETrER OF REQUEST FOR AN AMENDMENT DATE .>~/-o/ FEB ADDRESS ~ PROPERTY PHONE I/We ,3~.~m~ ~C. ~.~.~, request an Amendment to Permit # ~/~ }lq .L. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: ~TATE OF NEW YORF, OUNTY OF SUFFOLK ___~?~b___o._~.u,'~_O , re~sidin~ at ~ ~nu L-DO GO that i~ ~.le _.~_ aaz cf ~_ ,~f ~ d. eponent z~ll=.d ~ ~r ..... ~-~ c~. the Not~ce set ..ortb !n the Board of ~'rustees A~ptYcation, directed to each of the ~o~e n~ed persons at the add~sses set Dpposite there respective n~es; that the of said Uek'so:ls as s~ow~ on the current assessment roll of ths Town of Seuthold; that said ~etices were,mailed at the ~nited States Posu Office at ~r.~ Po,~ k{ ~ , that said Notices were mailed to each of said ~rsons~ (gertified) (registered) Sworn to before me this /~ ~ day of ~f~ ~ / ,~/ Notary Public ,;O~ .!E SALEMME ~.1 ...... O.~#York 01 -SA4800818 Ou~l?d in Su~lk Co?y,~ NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEESf TOWN OF In the matter of applicant: SOUTHOLD SCTM#~O00-~ g -Db'- YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request Permit from the Beard of Trustees to: Cons+r c ;nflC Ga'm,l¥ rcs,de_ncc 2. That the property which is the subject of Environmenta'l ~eview is locat~ed adjacent..to your nroper, ty-~nd is described as fellows: }OgO~ ~o~oOV~e~ ~L .-r. ~].~ I ooo- ~%.-5 - 67,1 · on *~ Nor+h S~e. 06 $o~n~v,e~o A~e~c, ~pp~x, ~+.cly e s+ of Dogwoo ¢nc ' 3. .That the project which is subject to Enviro~ental Review under Chapters 22, ]37 or 97 of , %n~ Town Code is open to public comment on: ~ ~1-0 You may contact the Trustees Office at 765-1892 or in writing. The above refe~ence~ progosal is under review cf the Bcard of Trustees of the Town of Southold and does not reference any other agency that might have to review same propcsal. MAILINC~ ADDRESS: /9.0. ~nz '702 . Kori4,,'O6]~'n-+';Ny 11778 PHONE ~: G3 ~ -- ~-~ ~/~ ' ' Enc.: Copy of sketch or plan showing proposal convenience. for your Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall · 53095 Route 25 P.O. Box 1179 Southo[d, New York 11971-0959 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 of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING i,Tg/~/~ /~/~'~[', residing at /7° ~//-' ~' being duly sworn, depose and say: That on the /3 day of F~'~ , 200;, I personally posted the property known as/Ob'O~' J'O~.~',~,,~ ~ ~~ ~T~ ~-o~-~ 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 ~earin~. Dat9 of hearing noted thereon to be held ~,~ Dated: Sworn to before me this /~/~ day of ?~. 200~ Notary Public Boa~f Trustees Application County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STAT~ENTS CO~AIN~ HEREIN ARE TRUE TO THE BEST OF HIS/HER ~OWL~GE AND BELIEF, AND THAT ~L WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MY BE APPROV~ BY THE SOUTHOLD TOW BOARD OF THUSTEES. THE APPLICANT AGREES TO HO~ THE TOM OF SOUTHOLD AND WE TOW TRUSTEES HARMLESS AND ~EE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING ~DER OR BY VIR~E OF SAID PE~IT(S), IF GRANTED. IN CO~LETING WIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AG~T(S) OR ~P~SENTATIVES(S), TO ENT~ O~O ~ PROP~ TO INSPECT THE PRRMISES IN CONJ~CTION WITH REVIEW OF WIS APPLICATION. / Si~q~ure SWORN TO BEFORE ME THIS /~~3~ DAY OF ~f. Notary Public 7 .Mbert 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) 765-18,92 Fax (516) 765-1823 BOARD OF TOWN TI~USTEES TOWN OF SOUTHOLD Offic~se Only Coastal Erosion Permit Application _~Wetland Permit Application Grandfather Permit ApPlication Waiver/Amendment/Changes ~'~Rec--~ved Applic~ ~'~Received Fee:$ -"Completed Applic _ Incomplete ... SEQRA Classification: Type I Type II Unlisted Coordination:(d~te sent) : ~-~AC Referral ~/~~ F Sent: _L~te of Inspection~_~_~ '~ .... . Receipt of CAC Rep rt: Lead Agency Determination: ~_~echnical Review: --Public Hearing He~d: Resolution: - - Name of Applicant ~/Z! /~ ~_~ .~ /~ (f~_ ~f~_~.~(.~.~[,~f~ Address /0 ~0~ ~ ~,~ ~~ /177f Phone N~er:(~/) 7~-- /~q Suffolk County Ta~_~ N~ber: 1000 - Dq- 37. $ Pro-ert n ;~ ~ ' ' P Y ocatiOn: =~0~ ~ ~ , ~~D- ~0 Pole $, d~ to cross Streets. and location) AGENT: ( If applicable~ Address: Phone: FAX%: 1 lrd of Trustees Applicati~ )f Land Area (in square feet): Area Zoning: ~ Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No__ Yes If yes, provide explanation: Proiect Description (use attachments if necessary): B~d of Trustees Applicatio$ WETLAND/TRUSTEE LANDs APPLICATION DATA Purpose ~of the proposed operatio~. '-,,,, c U,U ll ,l Area of wetlands on lot: square feet Percent Coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project 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): 617.21 Appendix C State EnvironmentaJ Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be comDle,"ed by Aoplicant or i~rolect sponsor) SEC 5. IS PR POSED ACTION: 7. AMOUNT OF ~ND~FFECTED; ,~ O ~¢ ~cres Ultime[ely acres ~. W~LL PROPOSED ACT[ON COMPLY WITH E:(]ST~NG ZONING OR OTHE~ EXISTING ~NO US~ ~ESTRICTIONS? 11. DOES ANY ASPECT~ OF THE ACTION HAVE A CURRENTLY VALIO PERMIT OR APPcIOVAL? Yes ~I~No If yes. list agency name and Derrn~llaooroval If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this asj~essment OVER PART III--0ETERMINATICN OF SIGNIFICANCE ~.To se comole[ed by Agency) of Trustees Applicatio~ County of Suffolk State of New York 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 MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOb"lq{OLD 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. ~Signa.~ S1 nature SWOP~N TO BEFORE ME THIS 50 DAY OF ,J--~ f 2oo0 Notary P lAURA HOGAN NOTARY PUBUC, State of New York No. 5009611 ~ualified in Suffolk County ,.~ '"" 0 Comm~ioa Eq~iles March ].5, 7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: 7~ /)%_~- '/-c~9/~ p-o. IV'or'fA Se c~ J-' P. mod~.lar 14o~mes ,S-hew. ~ 019o0 Address: goX ItoO, _pod-r-Hoc. o, IMy IIqT/ , P.O. l]ox /al t¢,cl<s 5+r., /~root<ly~ flc'gJ~ts ~IV Cl,¢fs ~ N.~. STATE OF NEW YORK COUNTY OF SUFFOL~ '~O/'/;U~r.P/~ , residing at ~ ~/~_.~ , being duly sw~q~_~eposes and says t~'on ~he ~-day of ~f ,~, 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 roll of the Town of Southold; that said Notices wgre mailed at the United States Post Office at ~6) C ~/ ~o,'~ , that said Notices were mailed to each of said ~ersons by (certified) (registered) mail. Sworn to before me this c'~O day of J~4~ ,~_~O Notary P~d ~RkH~N I NOTARY ~BLIC, S~t, o~ YOlK Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095MainRoad P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN T~USTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~0~ ~/~ , residing at // ~7- //77[' being duly sworn, depose and say: That on the day of , 199 , I personally posted the property know~l as /D~ ~0u~o/~/~ ~V~., by placing the Board of Trustees official po~ter where it can easily be seen, and that I have checked to be sure the poster h~s re~ained in place for seven days prior to the date of the public he~ri:~.._~d~a_te~o..~ hearing noted thereon to be held q',03 pin. Dated: Sworn to before me this ~Oday of ~T~,~ 7Qq 2000 Notary Public LAURA ~OGAN NOTARY PUBLIC, State of New ?or~ No. 5009GIt ~nature )~ U.S. Postal Service U.S. Postal Service CERTIFIED MAIL RECEIPT CERTIFIED MAIL RECEIPT (Domestic Mail Only.. No Insurance Covet,~ge P~ovided) (Domestic Mail Only: No Insur,~nce Coverage Provided) Certified Fee D Return Receipt Fee r--~ (Endorsement Required) [~ Restricted Delivery Fee Postage '77 / ~'S U.S. Postal Service CERTIFIED MAIL RECEIPT fDomestic Mail Only: No Insurance Cover,~ge Prowded) Certified Fee RehJrn Receipt Fee m U.S. Postal Service CERTIFIED MAIL RECEIPT (Domestic Mail Only: No Insur,~nce Coverage Provided) m ._.~.._.o L ......... ~,-~.~.dmJ.~r ~m ez CERTIFIED MAIL RECEIPT [Name lease Print Clearly) (To be completed byml~lle~[~.__..~__ J ...r~.~.~__~..±k..S.~.~...~.~S_~.C]. ..................... LSt~t, Apt. NO.; or PO BOX NO. I ...P....:_O.:._..~.~__~..I~,_., ................................................ Postage Certified Fee FU [Name (Please Print Clearly) (To be completed by mailer) ,~ ..... m.~r.,.._~,~l~,~.h ........................................ II" IStreet, Apt. NO..I or PO . j I "-L ~:.0.,__.B. oz..__L6~ ~ .1 APPLICANT ' - TRANSACTIONAL DISCLOSURE PORM The Town of Southold's Code of Ethics prohibits con£11cta o~ 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 allott it to take whatever action is necessary to avoid same. (Last namb, first hame, middle 'init'i~'~"unlee~' ' you are applying in the name o~ someone else or other entity, such as a company. If so, indicate the other person's or company's name.) NATURE OF APPLICATIONt (Check all that apply.) Tax grievance Variance Change of zone App[~al of plat Exemption from pla~ or official map other (If "other," name the activity.) parenh, or child) huv~ a r~lu~ton.hip vl~}l any o~fluer or ~mployee o~ the Torn o~ Southold? "Relation{hip- include. by blood, marriag., or busin~s. Interest" means a business, inuludin~ a partnership, in .hich the town ofiic.r or employee has even a partial ovnership of (or employment by) a corporation in which the torn officer or employee owns more than 5% of the shares. YES NO ~ If you answered #YES,#. complete the balance of date and sign where indicated. thio form and Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer sr employee. Either cheok the appropriate line A) through D) and/or describe in the space provided. c) The town officer or employee or {lis or her spouse, sibling, parent, or child is (check all that apply), __A) the owner of greater than §% of the shares of the corporate stock of the applicant (when the applicant is a corporation); the legal or b~neficial owner of any interest in a noncorporate'entity (when the applicant is not a corporation)/ an officer, director, partner, or employee o£ the applicantt or the actual applicant. DESCRIPTION OF RELATIONSIIIP PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK ~/0~/~ , residing at ~ ~/T/X~..z~ , being duly sworn, deposes and says t~ on ~he _~_-day of _~ ,~C~, 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 roll of the Town of Southold; that said Notices wgre mailed at the United States Post Office at ~6) C ~/ Po,'~ ~ , that said Notices were mailed to each of said ~ersons by (certified) (registered) mail. Sworn to before me this day of ~%A~ ,~_~O Notary P~4 NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF In the matter of applicant: SOUTHOLD SCTM#1000-5~-O~-37, Z YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: ~0/LL) /~ ~-~ ~/~/L~ ~,el/,~9 / £~ D~ ~- ~?~ ~ Ce~-. 2. That the property which is the subject of Environmental Review~s located adjacent to your property and is described as S~u~-o~ ~{/1~ 71 3. That the project which is subject to Environmental Review under Chapter~ 32, %~, or 97 of the Town Code is open to public comment on: %JO~[~ You may contact the Trustees Office at 765-1892 or in w~iting. 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 PHONE ~:' 1~31 Enc.: Copy of sketch or plan showing proposal for your convenience. Albert J. Krupski, President James K]vg, Vice-President Henry Smith Artie Foster Ken Poliwod.- Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 1197! Telephone (516) 7e5-18~2 Fax (516) 765-182:3 BOARD OF TOWN TRUSTEES TOVFN OF SOUTHOLD BO;~RD OF .TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of CObqqTY OF SUFFOLK) STATK O? NEW 'YOP~K ;' AFFIDAVIT OF POSTING lng ~uly swoi-n~ depose and say: That mn the day of ~ o , ~9 , I personally posted the property nno~.~.t as //~5~0~ .~o~/~'/~zo ~V~., ~6~0· ' by placing the Board cf Trustees official Do~ter where it can eosily be seeR. and that i have checked to be sure the poster n~s re~ained~ place for seven days prior ~o the ~ate ~b~ic he'~rln~._~te~q~ hearing noted ther~cn to ~e ~.eld Da~ed: Sworn to before me this ~Oday of ~-~ ~,~,q 2000 Notary Public LAURA H~AN NOTARY ~BLIC, S~ of New No. nature )' i "1 i .... JUL-3 2000 lEE' ,'. ~ard of Trustees ApplicatJ County of Suffolk State of New York 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 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. ~Signa~ S1 nature SWORN TO BEFORE ME THIS ~O DAY OF ,%~ 2oo0 N'otar¥ Pu. Bli~ LAURA HOGAN NOTARY PUBLI~, S~te of New York No. ~H '. ,,. J~ - 3 2000 ~<-._ .? .. TRANSACTIONAL DISCLOSURE The Town of Southold's Code o£ Ethics prohibits conflicts oE interes~ on ~he par~ of town oE£icers and emploFees. ,The purpose of ~his form is to,provide lnforma~Lon which can aler~ ~he ~own of possible conflic~s of in~e~es~ and allow i~ to take whate~ action is necessary to ~.id same YOUR N~gt (La~t~m~, ~ir~t name, midd.l~ you a~applying in ~he name o~her 6n~i~y, much as ~ company. If ~o, indicate NATURE OF APPLICATION~ (ch~ck all ~ha~ apply.') Tax grievance Variance Change of zone App~l>val of plat . . Exemp~ion from plat or o~icial map Other (Ir "other," name the activity.) Do you personally (or through your eompany~ spouse, sibling, parent, or child) hav~ a relation~bip with any of[leer 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 ownernhip of (or employment by) a corporation in which the town o[ficer or employee owns more than 5% o~ the shares. YES NOf If you answered "YES,". complete ~he balan~ of ~his ~orm and date and sign where indicated. Name of person employed by the Town of Southold Title or position nE that parson 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 parent, a) c) DESCRIPTION officer or employee or his or her spouse, sibling, or child is (check all that apply), the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation)~ the legal or bkneficial owner of any interest in a non~orporate'entity (when the applicant is not a corporation) ~ an o fiuer, director, paean.r, or ~mpioyee .' q Ltq i. appiluankl ut ' i'~]F ....... the actual applicant. ],~j R~LATIONS{II P J.P. HODULAR HOMES, INC..~oj LOCATION HAP VAC, ANT .............. 2' D*~ a~ 5A~Y LOAN 0 .............. i~, .~,~o SITE PLAN NOT TO SCALE para, 2/IO/OO ELEVATIONS ~EFER TO NSCVO/USOVO 14' HIN. 14' ~IN,