HomeMy WebLinkAboutTR-5459
Albert J. Krupski. President .
James King, Vice-President 1
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 23. 2002
Mr. Andrew Nikolich
89 Kingsbury Road
Garden City, NY 11530
RE: SCTM#56-5-15
850 Budd's Pond Road
Southold, NY
Dear Mr. Nikolich:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, May 22,2002.
RESOLVED, that the Southold Town Board of Trustees Approve an Amendment to Permit
#5459 to install 275 gallon steel tank for #2 heating oil on concrete pad (3'x6') above ground
along outside wall of the garage wall.
If you have any questions, please call our office at 765-1892.
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Albert J. Krupski, Jr.
President, Board of Trustees
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AJK:cjc
Building Department
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
1st day of construction
Y, constructed
~ Project complete, compliance inspection. 1/1. Î Iv {-
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Date: January 15,2004
Andrew Nikolich
850 Budd's Pond Rd
Southold, NY 11971
Board Of Southold Town Trustees
Southold, New York
Re: Permit No. 5459
Dear Sir/Madam,
·[d
This is to advise you that all the work authorized under the Permit No. 5459 has been completed in
accordance with the specifications, drawings and special conditions.
Sincerely,
\õ),!: C Ii: 111 ¡¡: ~
l\ru JAM 1 5 2004 IUd)
Andrew Nikolich
Southold TOWA
Board of Trusfees
r
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Telephone
(631) 765-1892
Town Hall. 53095 Maio 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 ofTrustees OISAPPPROVAL
of the Amendment Request of ANDREW NIKOLICH to Amend Permit #5459 to install
275 gallon steel tank for #2 heating oil on a concrete pad (3'X 6') above ground along
the outside of the garage wall.
Located: 850 Budd's Pond Rd., Southold. SCTM#56-5-15
The CAC recommends Disapproval of the application because the proposed project
was not staked.
Vote of Council: Ayes: All
Motion Carried
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New York State Department of Environmental Conservation
Division of Fish, Wildlife & Marine Resources, Region One
Marine Habitat Protection
Building 40 - SUNY, Stony Brook, New York 11790-2356
Phone: (631) 444-0295 . FAX: (631) 444-0297
Website: www.dec.state.ny.us
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Erin M. Crotty
Commissioner
AMENDMENT TO PERMIT
May 1,2001
Mr. Andrew Nikolich
89 Kingsbury Rd.
Garden City, NY 11530
Permit # 1-4738-02966/00001-0
Location: 850 Budd's Pond Rd
Southold
Dear Sir
N/A Your recent request to extend the above permit has been reviewed pursuant to 6NYCRR,
Part 621. The expiration date is extended to
-X..- Your recent request to modify the above permit has been reviewed pursuant to 6NYCRR,
Part 621. It has been determined that the proposed modifications will not substantially change
the scope ofthe permitted actions or the existing permit conditions. Therefore, the permit is
amended to authorize: construction of a 6' x 3' concrete pad for a 250 gallon above ground
oil tank. All work to be done according to plans stamped NYSDEC approved on 5/1/02
This letter is an amendment to the original permit and, as such, shall be available at the job site
whenever authorized work is in progress.
AIl other terms and conditions remain as written in the original permit.
Very truly yours,
\
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Depury Regional Permit A ministrator
cc: BMHP
File
~:l -1 - / r .
February 4, 200l
Andrew Nikolich
850 Budd's Pond Road
Southold, NY 11971
Board of South old Town Trustees
Southold, NY 11971
RE: Permit No. 5459
.
The approval to proceed with the improvements as outlined in your authorization dated December 21, 200 I
and the condition of 10' non- turf buffer installed landward of the bulkhead appears to be in contlict with
the DEC Special Conditions (attached). Perhaps you may want to take a look at the disturbed soil on the
property as it appears to me sandy non· turf type. The plants by the bulkhead were of several types that can
tolerate that type of soil.
I can make myself available on the day of your next tour of inspections.
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Very truly yours.
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Andrew Nikolich
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NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CONSERVATION
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SPECIAL CONDITIONS
1. Any debris or excess material from construction of this project shall be completely removed from the adjacent area
(upland) and removed to an approved upland area for disposal. No debris is permitted in tidal wetlands and or
protected buffer areas.
2. All areas of soil disturbance resulting from this project shall be stabilized immediately following project completion
or prior to permit expiration, whichever comes first. The approved methodologies are as follows:
a. Revegetate area to its pre-existing condition.
3. Driveways and parking areas shall be constructed of pervious material.
4. This permit does not authorize any alteration, expansion or replacement of existing septic systems.
5. Roof runoff shall be directed to drywells on the landward side of the house.
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DEC PERMIT NUMBER
1_4738-02966/00001
PAGE 4 OF 4
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TERMS and CONDmONS
Andrew Nikolich
The Permittee
residing at 89 Kingsbury Rd.. Garden City N, Y., as
part of !be coosideratioo for the isSo'.nœ of che Permit docs III>deøtaod and prescribe to the fo1-
lowiDg :
1. That the said Board of Trustees and the Town of Soutbold are released from IS1'f and
aU damages, Of: claims foe damages, of IIÚØ arlsiag cIhecdy 01: indireody as a result of IS1'f ~.
atioa pedOllllCd p""'aat to this petmit, and the sold ........._ will, at his or her own eq ..I":,
delead IS1'f and all such ucs·inIt/-.d by tbird porties, and !be sold p..... 1/(- -- faU 1iIIXUty
with respect theteto, to !be OO"'plM~ exclusion of the Board 01. Trasttes 01. the Town 01. ~
2, That this Permit is'..and for a period of 24 mos. wbkh is <oDSi~ 'ed to be !be
eon-led time' required CD con.pIde the work in'9'Ol~ but sboa1d cm:umsw>ces ....-rant, request
for aa exœasion may be made to the Board at a 1aœr claIIe.
~. That this Permit should be rdaiøed indef"mitely. or as loog as the said Permittee wisbcs
to ....¡.....in !be srruaure or project involved, to provide evidence to anyooe ~ that ...m-
orizatioo was originally obtaiøed.
4. That the work /nvol~ will be subject to the ~ and approval of !be Board 01:
ia agents, and noo-compliaoce with. the provisioDS of !be origi_flng appUcatioo, ø.y be cause £01:
rewc:alÌoa of this Permit by resolutioo of the said Board.
5. That there will be no unreasooab1e interfereace with aavigatioa as a result of !be wod<
berein ...thorlzed. '
6. That there sba11 be DO iøterfereace with the right of !be public CD pass and aepess ùoag
the bea<:h between high and low _ter marks.
7, That if future operatioas of the Town of SouthoId require the reIIIOftl and/OI: alCleralÌOOS
in the 1ocatioø. of the work berein ød>u«h.M. or U. in the opiaioo of the Board of T.-, the ,
work shall cause unreasooable obstructlOQ to free navigotioo. the said ..........- wi11 be rcquIœd.
upoo due nodœ, to remove or alter this work or project berein stated without ~ to the Towu
of Southold.
8. That the said Board will be notified by the Permittee or thc ~, of the wad< ...m-
odzed.
9, That the Permitœe will obtain all other pennies and coaseais dJat ø.y be required sup-
plemental to Ibis permit wbkh may be subject to revoke upoo fai1ute to obtain same.
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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
December 21, 2001
Mr. Andrew Nikolich
89 Kingsbury Rd.
Garden City, NY 11530
RE: 850 Budd's Pond Rd., Southold
SCTM#56-5-15
Dear Mr. Nikolich:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, December 19, 2001 regarding the above matter:
WHEREAS, ANDREW NIKOLICH applied to the Southold Town Trustees for a permit under
the provisions of the Wetland Ordinance of the Town of South old, application dated November
28,2001, 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
December 19, 2001, at which time all interested persons were gi ven 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,
WHEREAS, the Board has determined that the project as proposed will not affect the health,
safety and general welfare of the people ofthe town,
NOW THEREFORE BE IT,
2
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RESOLVED, that the Board of Trustees approve the application of ANDREW NIKOLICH to
install 125 linear ft. ofC-Loc Series 4500 vinyl sheathing on inside of the existing bulkhead.
Extend second-story wall of the existing bedroom and eliminate second-story balcony. Construct
second-story addition over existing garage. Install accessory building (IO'X 8' shed), and
restore circular driveway. All improvements approved with the condition of a 10' non-turf buffer
installed landward of the bulkhead and the driveway improved with a permeable surface only.
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 project will expire two years 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,
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Albert J. Krupski, Jr.
President, Board of Trustees
AJKllms
DEC
Bldg. Dept.
Telephone
(631) 765-1892
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Town Hall. 53095 Maio 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 Thursday,
December 13, 2001, the following recommendation was made:
Moved by Bill McDermott, seconded by Scott Hilary, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH
CONDITIONS of the Wetland Permit Application of ANDREW NIKOLICH to install 125
linear ft. of C-Loc Series 4500 vinyl sheathing on inside of the existing bulkhead. Extend
second-story wall of the existing bedroom and eliminate second-story balcony.
Construct second-story addition over existing garage. Install accessory building (10'X 8'
shed), and restore circular driveway.
Located: 850 Budd's Pond Rd., Southold. SCTM#56-5-15
The CAC recommends Approval of the application with the following conditions:
1. A 20' non-turf buffer behind the bulkhead.
2. The applicant setback the shed as far as possible from the bulkhead.
3. The existing walkway is removed and replaced with permeable material.
Vote of Council: Ayes: All
Motion Carried
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Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Main Road
P.O. Box 1179
Southold. New York 11971
Telephone (516) 765-18q2
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
LEITER OF REQUEST FOR AN AMENDMENT
DATE
ß1/ 2(!:)c?z
OWNER
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JJ <¡ 1/m'ì.f6u,,'I )?d
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PHONE (6-16) 7'1'6-,3'/37
0ovde¿,¡ Ct #Y' 11'.5""30
PHONE
ADDRESS
AGENT
ADDRESS
PROPERTY LOCATION
TAX MAP NO.
.9 .SO ß (/.tø~ .?OJVLI. R..o
IIWe I request an Amendment to Permit # .6-,ý.5""9
/0 I",f.!../I 275 0'...1 J/~e I ,7,;"" f:- ~r #e #e"'-'/""'''7
tß, / t5>Y1 cL C-e>""C;(~él~ "Pad r 3<><"6' ') o6oo/l!. 7~t!J<J""'CJI
ðt liÞ<A. ,.Y',fe~~/:! a.> -r- rã e ~tO-VðJ 7~ <-0«<> /1 .
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Signed By: N~ I~
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TERMs ud CONDITIONS
Andrew Nikolich
The Permittee
<aidiac at 89 Kingsbury Rd.. Garden City N. y.. ..
!Ilt of che coasideradoa for the isiIuaøce of the PermIt cto. IIødontaad IIDd pcacribe 10 the foI-
~I
1. TIw che aid Bootrd of Tnucee. IIDd me T....... 01 JInv.&.ol<;¡ _ ftIeaaecI 1_ aay IIDd
aU ~ CI(' claims lor dama&w. of aula uisiac dirocdy or Iadir~ .. . ~ of ...,. ~.
adoa pedocmecl pulWlDt 10 this peIIDit. IIDd the aid p¡.....J 1 will, IIC Iaia or her _ "X£ I,
delead ...,. IIDd aU aacb 1111111' WdaW b, tbhd Padea. .... the aaid r.. ""1)0" _ -.... IaU IiIIIIIIt,y
Iritb nspect chereIO, to .... -.....eo:da1oa 01 the Baud of Tr.eea ol the T_ 01 lIa I ~
Z. That this Peamt fa wUd lot . pedocI 01 24 _ which fa __.L' ..4 to lie the
__red dmerequiœd 10 .......,lele the wotk ia~ "'t ihoaJd w.. .. _... --. ~
lot ... ezteas/aa may be IDIde 10 che Baud .t . Iatec cIace..
3. That this Permit should lie -u-t iodefiaiœly, or .. Ioag .. dae aåd PeaaItaee wiahea
10 ....,-1.. the lUuCtute or project ù.YOIved. to pt'OVide erideace to aIIJOae aIßOetDed that -..
otIzaâoa .... otiøiaaUy obtaà.ed.
4, n.ac di. wock bol""" will Ix: aubject to the ~ ud &pproftI 01 the Baud or
ia -.au, ADd œa-œmpI/UIœ wicb rœ ptOYisioaa ol dae oria/_fl... appIbtioø, _y be _ for
IftOCatiaa of this Permit by moJutioa of dae said Boud.
s. TIw d...e will be no -.able iaterlereoce Iritb aa....tiocI .. . ~ 01 che wotk
beteIn ~.
6, 'I1aat d...e IbaU be DO iøteñ__ with the ri&bt 01 the pabIic 10 ..... .... npaII ..
die belch benoAaO hiøb IIDd low _!let' marks.
7. 'I1aat il future opendœs 01 d:e Town of -"""Id nc¡ahe !be -.. ud¡or ~ '
ia die 1Mo·¡".. 01 die wodc heœiø .'1vorizecI, Ot ii, ia the ......-'w. ol the Boetd ol T-. tile
-.:Ie IbaU cause uateuoaable obscraalOG to ltee aaTfcotifta, die IIdd P I ~ will be qq.........
apoø clue aodœ, 10 remove Ot útet chis wotk or PMject beteIn bred wltbouc fZ! _ to the T.......
ol Soulbold.
8, That the aa.ld Boatd ..111 be "'>Iified by the PetmIaoe or the r .I~~.. of the wotk IadJ.
orized.
9. Th.t the Permittee wiD obca.. aU othet permits IIDd _ daat ..., be NI UÙed ....
plemeolal to dù. permit which _y to aub ect to reYoke upon lúIare to oIxaIa _
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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
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BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
~ ÎAO;
____________~~-~6-'1-~---------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, jl"vfl£W N/la>/-IUI
ba,der1 C;17 IVY
being duly sworn, depose and say:
That on the g~ day of p107 ' 2002, I personally posted the
property known as eso ß~~ p~~ ~D
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~e
public hearing, ,Date, of hearin9 noted thereon to be held ),
~ 'J- p--J. IJv. ~ 7tJ I ~ f . /I'J .
, residing at
J''l Jlmf..f ¡'v;'
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Dated:
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(s,!gnature)
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Sworn to before me this
10 day ~;,
Notary Public
J
MA!i',¡;,'::HI .-.~:,_\. ..Lt:_ S(.:I::-",~,__:'. ¡i
Norar'i Public. ',:¡: ,[è uf Nt:w YQrk
No 02SC~O"¡'3553
Qualified In Nassau Cl)unty
CommissIon Expires May 8. ~ cJO '3
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Apri129,2002
Andrew Nikolich
89 Kingsbury Road
Garden City, NY 11530
Board of Southold Town Trustees
Southold, New York
RE: Permit No. 5459
I am requesting an amendment to the above referenced permit to install a 275 gallon
steel tank for #2 heating oil above ground on a concrete pad along the outside wall of
the garage.
Very Truly Yours,
,¡LLvJ /~~
Andrew Nikolich
£0/~0'd
8£0T¿¿Þ,£9,6 01 S~Þ~8SS8,¿
NOI1~~lSINIwa~ HIW ~~ 60:9, ~00~ 6~ ~d~
_ Albert J. Krupski, President
James'K.ing, 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
Office Use Only
_9>astal Erosion Permit Application
~etland Permit Application ...- Major
_ Waiver/ Amendment/Çhanges '
...-Received Application: 1/7 ~ !JOI
~ceived Fee:$ Jt::J::J...
_~mpleted Application~
_Incomplete
SEQRA Classification:
Type I_Type II_Unlisted_
_COO, rdination:(dateøent
:7éAC Referral Sent: _
.....-r5ate of Inspection: I - fuIVl\ [<~ '
_Receipt ofCAC Report: I
_Lead Agency Determination:
Technical Review:
-Public Hearing He~
_Resolution:
Minor
t'
Name of Applicant
,4N~IZCV\l /'II Ko¿.iCU
Address~ /ân9s/x!r-y Rd·
I /
0ardel? C~ ¡1/Y,
I
Phone Number:( ) 516 - 7#6' ·.3'Y37
Suffolk County Tax Map Number: 1000 - .:>-6 - 0 S - /5
Property Location: 9 SO BC/OD1..s PD/I/.CJ I<DAL)
I- c¡ h(!1ttJ f.=-i /o$tlf/lö/l'le Rd.
(provide LILCO Pole #, distance to cross streets, and location)
.Sou TN". 0 N.':f, / / "17/
I
AGENT:
(If applicable)
C~Ol
?0\1\
Address:
Phone:
.
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Board of Trustees Application
GENERAL DATA
Area Zoning:
16. 720
,
I =.5 id~" -!-to /
¡l:esu:/ e#? h ~/
~ e .s'lcI eN'¡'¿' /
Land Area (in square feet):
Previous use of property:
Intended use of property:
Prior permits/approvals for site improvements:
Agency
Date
$o,,¡âJ or S<><ff,<t:¥:!J 7bo.LM 7:C~S
'1'fr.9þJ> ¡'FoK/·,.,T # /277/
/ I
_ No prior permits/approvals for site improvements,
Has any permit/approval ever been revoked or suspended by a governmental agency?
./' No_ Yes
If yes, provide explanation:
Project Description (use attachments ifnecessary)@ j,.s~/I¡2SÞ~rklpfC-,áJC'<- .sen""J: .ý6Q::>
¡I'/Ilyf s¿ee47 1M /H,fttR 0.( l¿eeY'.¡-,{7 Z,,/¿kd @ Exk".J Z,,<f' f,f,?, wQ11 ót r'k <!'Yt.I'''W':l
adtl,¡,..... .
beodr__ /e~"'ll?vr;" .?"e/~r-y WKóny_ ~ ("_.j'bcI2ncl..f~r7rt?ver e,ICts,lM,J
ía"~íe. @ /n,¡;bl/ ðCce./'./'Drý b<ll/Ø'l (¡ð7,p') (,f',{ecl'),_
ØJ ,R~i".,0re dt/~o/ ,N' .rkUJrl "'..- /~~ ð;'jl""'CZ/ c:hb<tH',/ ' (C'rr-c"Æur ~rr-"'/ )
· .
Board of Trustees Application
County of Suffolk
State of New York
/t.t.D¡Ii?EvV # ¡¿oL. ¡ C ¡..¡ BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HElSHE 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
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
~/~~
/ fignature
SWORN TO BEFORE ME THIS
277" DAY OF /~J(?IHbeí
200/
'-
J91ijL
Notary Public
MARYBCTH P,,"SCALE SCISCENTE
Nma:y r:'ubllc. ':.:[,'>;e of ì~ðW York
No.02SCS)4:;S53
QU.3I,tI.;-d in r~.3~~·au County
Commos"on E'p"es r"'ay 8, d.. ú D?
617.21
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor,
,. APPLICANT ¡SPONSOR 2. PROJEC: NAME . :yL
¡4/V/J1<EW ¡JI ¡.LCJJ.i c,¡¡. ¡p"'or-t~ry ¡,,,/,/VtI,!,,,.u·'"
J. PROJECT LOCATION: I
MUnicipality St!>&./ Tlløt..!) County SC/¡:-r&J¿' ¡,£
4. PAEC:SE LOCATION (Street address anð road Intersections. prominent landmarks, 91C., or provloe .-nap)
1-'-16-4 rZ/B7)- Ti!xt 12
I p~OJECT 1.0. NUMaE"
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SEa
.!?-5-D BC/~d'.s
;30/76/ -"tbod
5. IS PROPOSED ACTION: \..../
o New D( Expansion b(! MoClíficatlon/aUeratfon
6. DESCRlaE PROJé'C1' aRIEFLY: r. K<=,SkeI/lt.. ey,,r..4n:t Bq/H-ecwr/' Z ~ ,ç/,_'n~-/~ 2"'/.1''''''''7
dect. and ",a;,rpoFak -Iii.. Jr.-Dee ".~c> 2"'~ .f-,4ry Bed'..-·
3. Co~c-I znél..lÝcr)' C7tb'if'.t:Þ," O;.le/ ¡f?YIJ'.,IIHZ JcuOlJe
1./.' CD....r-k-ud aC"'¡:V.k>rl bIde¡ (..It"",) 10')(:&"~
S. Clf>Þ1Jk",c'¡ co"cur",; dr/ve'J . .
7. AMOUNT OF UNO AFrECTED:
!nltiallv acres
Ultimatelv
/l71rl,;"Q/
acres
3_ w~ ,::QO?fJSED ~CTI0N CCMPL'( WITH ¡:XISïING ZONING OR OTHER EXISTING LAND USE ::1.EST¡::¡IC710NS?
A Yes 0 No If No. describe briefly
g, V!H TIS ?RESENT LA/"~D u~ë. IN VICINITY ~F ?ROJECT"
I ::¡es¡denlial rì.~naustnal ~ C.JmmerClal
esc~IDe:
o AgricUlture
~ P::m:/ForestlOoen soace
~Other
10. DOES ACTION INVOLVE A ?'=.FtMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY .'=ROM ANY OTHER GOVEMNMENTAL AGENCY ¡F=ùERAL.
5T A TlY¡=¡ LOCAL)?
)ðJ Yes 0 No !f yes. !ist agencyts) and permrlfapprovaJS
I· 'J)EC
2. J>ErAÆï"'t-",r or B UIL.J)/NG..5
-r
". DOES ANY ASPECT OF THE ACTlor~ HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
o Yes· X~o If y~s. list agency name and permJUapproval
12. AS A RESULT OF PROPOSED ACTION WILL S<ISTlNG ?ERMIT/APpqOVAL ?:E·::;¡UIRE .'v10QIF!CAÏlCN?
DYes ONO
¡ CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE -0 TH::: 3ESï OF MY KNCWL'::OGE
Applicant/sponsor J1ame: ~N/JIlEW NIIJL:>¿,Ci-I
Signa,",", hJ )'-'W..ú.øM
D.Hi~:
I/Z..i,Þ/
I '
/
I /
i
I
If the action is in the C02stai Area, and 'IOU are a state ac;ency, complete the
Coastal Assessment Form beiore proceeding with this a:j.~essmen:
OV!:::R
:... ~OE5 AC7;C~ ::.:..:C:::~: ':'NY
. ~';'~s ¡-,\lO
. .3MENï 1-:-0 Je r::::r.::::ie~e'J ~'{ .-\çe::c .
,~!:.. 7¡",,'=,E.5¡-;CL:'!N oj ·',¡':'C2.=. ::O:..F.Î 5~7.·:;:" :1 yes. :ocra,naI9 :ne '~VII!'H :roc~:s.3 ana 'Jsa :ne "='JL:... ~'AF
?ARï 11-=N'JIFiO~~MENï~'
3. 'NIlL .:..C7:CN .=l.E·::::;YË ·:::CROIN..:..72J .=lE'f!EW ...5 ~RC'JICEO =':R :.;NL57"ËJ .:..::;7:CN5;N 5 .\I,(':?R. ::Io1.;;-T '5; :-.57
may oe suceeseCec :Jy ~nc{r;ee .nvOIvea ac;enc·l.
.I .'{O. 1 ·,eç3.(:ve :~c;.ar:=.
L' Yes ~ ~O
C. C::ULD ":'G"';".iCN .:::o.E5UL7 ,N ANY ~OVE¡::.SE :::::::~':,5 A5SCC:":' ï~0 ·...,¡ïr-! -:~!: .=·JLL~v'J!NG. :AnS'Ners .T,;:¡y :e ';:¡na'Nm!e~. .f :e';ICI~t
C1. ::.'Clsllng 3M c:ualil'(. :>uctacs JC ¥Ol.:nowale~ cualiry JC :I~anllty. .'OISð ;e·f~ls. :x!s:lng :rartic ::at:ërns. $0110 .vaSie :¡roca.:c::.:::n J( Jls.:.:
:lOlen(lal for ':!(OSlon. .::ralnaqe ae :looClnq JrOOlems'? -:":,:olaln ::JClerly:
C2. Aesthetic:. ,;¡çricultural. ]rC:1aeologIC3.1. :-1Is;:onc. Jr Jlher .,atural Jr cultural ;esourcss: J( .::.::¡mmunlty or :"1elçnCcrnooo c:-:arac:ec" =XDlam ~,
C:. Ifeçelalfon or ~auna. :Isn. s~eltflsn or 'Nlldllfe s.,ec:es. $Ignliicant ."acllals. Jr :hre-atenea or ~ncançerea :scec:es? :.xclaln :Jr!arly:
c~. ~ <;::mmunlty'S existing ,Ians or goals as oH!c:ally aaooteo. or a cnange In use or intensity r.H use at !and ar olher natural resourcas? :.xplaln ::.-
CS. Growlh. subseouent :evelooment. -,r relateo ac: vltres likelY !O :)e ,nducec 'JY !he ;Jrccosec aC:lon? =xOlaln :Jr1eily.
':5. '-ong :erm, 3nOft :erm. '::.JmuJallve. or otner ':!rfec:s nOI rcentlfieo in C:..:S? :,'C;Jlam ;)C!erly_
,..
·::tr:er :moac:s .;nc:..Jclnç :::-:ançes ,n 'Jse at ;!t/'ler quanUly .')r :y¡:e or ;nergYJ? :.:t:)l,;,tn ::Clerly.
.j_ 5 THE::'E. :A :5 7ï-;Ë~E ;_:~ë:-'f 70 3E. :::;Nïï=\GVE?S'f ~e!...A. ït=:J -:-0 ~OTENÎI":'t. ..:.Gv:'~Së =NV¡RONME~~,;'L ;.'.1Po..C7S?
_':'es
~~o
:t ':'es. ':!xclain 'JC1elly
'ARi III-OEiERMINAiICN OF SiG~IFICANCE ¡To ~e camoleted ~y Agency)
!NSTRUCiIONS: For ~3C:"1 adverse ~tfec: identified acove, determine whether it is SUbstantiaJ. large. :mcortant or otnerNlse signlric.
=ac:1 ~ifec: snould be assessed in connection 'Nllh Its (3) setting ti.e. uroan or rural}; (bl probacility of oc::~-rog; (c duration'
irre'¡erslbllity: {e, geogracnic 3ccce: ana (f magmtuae. If necessary, add attachments or reference supporting marerials. ::1sure
eXPlanations contain sutfic:ent Jelali to snow that all relevant aaverse impacts have been iaentifiea ana adeQuatelY aCCresseo.
-
C:'ecx: ~his box if you have identifiea ene or "'ore ;Jotemially larçe or significant aQ'Jerse imoac:s 'NhIC:1 ,".tA·~
oC:::.Jr. Then :)rcceea airec:ly to ~ne ¡::ULL ::A.F 3.nO/or preoare a positive' aeclaration.
C:'ec~ :his ~ox :r you have determined. based on the information and analysis above and any suooor~iiiC
doc"Jrr:enratlcn. :haI ~r.e :JrocoSeO ac~ion WILL ,"JOT result inJoy significant ad.verse envircnmenral imcac::
A.ND .:JrOVlce ,In 3..tac:u",;,,\ents .3.5 necessary. the ~easons supconing this determination:
....'.r"~ '11 _"..oJ .....t:nC·f
...."nlo3. v¡;:" '<..rfI+!' JI <~')won\,o'" _II,C-::( .n '_"..0 ~O:t;n':"
:,{I" 01 .(~·'Don~'OI<: r..JI!'.:;;~r
;.t;nJ!U/~ }/ {~\con~,o'l:' ''':¡:,c.:-r .n ~"..!a .\.;~n.:;;"
).'(nd:u,e H "'~':":J.H~' ~If JII:~'~nt :rom 'eSOOn\.D'O: :)[IICi"
,J.ltC
o
.
.
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
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
_ J1 'Odnw_ hi!1a\CcJì _ _ _ _ _ _ _ _ _ _ __
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I, ¡1NJ),e£vJ Mi<()¿.,UL
Gw-den C,ly ¡..¡y.
,
being duly sworn, depose and say:
That on the q II. day of j)EC¿H4f~200 I j I personally posted the
property known as 3-:;-0 3u"ðéÇ POND ¡.?Ò
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 ~~,lqIJOoI
Of\C> ObC~..t;\ ì',CD rm.
, residing at
(J 'í JlU7/sburt Rd
,
Dated:
D<=c. i 3 '2 e>c.>/
I
Sworn to before me this
/.3U- day of~ 200 I
~~
ignature)
~ {l.ß'../
Notary ublic
MARY C. FEE
NOTARY PUBLIC, State of New York
No. 4942529
Qualified in Nassau Counlj
Commission Expires Sept. 26,;¡12Q.:I..
-
APPLtCANT
TRANSACTIONAL DISCLOSURE FORM
.
.
_Ie Town of Soubhold t s Code of J;:bhics prohibHs contllcbs of
inberesb 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.
YOUR N/\.HR.
;..J¡ ¡¿oL I Cµ ßNDI¿~',,^./ / :;,,:,,'-::i;+::¡t!'~.'
(Last name, first name, mldd~e 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.)
.
NATURE O~ APPLICATION. (Check all bhat apply.)
, .,':~h';:J. "'-. .,' I~. ,.I". t*
Tax grievance
variance
change of zone
^p.Pípval of plat .
Exemption from plat or official map
other"'/ . f '
(If "Other," name the acbivHy.) /2es/'ee..f,;¡ () . l3l/IIt.¡'~oQ
Do you personally (or ~hrough your cOMpany; spoune. sibling,
paren~. or child) hove a rela~ionship with any officer or
employee of ~he Town of Sou~hold1 -Relationship- includes
by blood. marriage. or business interest. MDusiness
interest- meann a business. including a partnership, in
which the town officer or employee has even a parbial
ownership of (or employment by) a corp.oration in which
the tovn officer or employee ovns more than 5% of the
shares.
YES
NO
/
..,.
If you answered ·YES.- complebe bhe bàlance of ~bis form and
date and sign where indicated.
Name of person employed by bhe Town of Soubhold
Title or position of that person
Describe the relationship between yourself (bhe applicanb)
and the town officer ør employee. Eibher check the
appropriate line ^) 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),
^) the owner of greater than 5% of the shares of the
corporate stock of the applicånt (when bhe applicant
is a corporation)/
B) bhe legal or beneficial owner of any inberesb in a
noncorporate'entity (when bhe applicanb is nob a
corporation)/
C) an officer, direcbor, parbner, or employee of bhe
applicanb/ or
D) the actual applicant.
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