HomeMy WebLinkAboutTR-5664
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Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
Town Hall
53095 Route 25
P ,0. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
February 16, 2005
Mr. & Mrs. Robert Schiavetta
P.O. Box 714
Southold, NY 11971
RE: 320 TARPON DR., SOUTHOLD
SCTM#57-1-3
Dear Mr. & Mrs. Schiavetta:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wed., February 16, 2005:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to
Permit #5664 to include a retaining wall 40' long and between 27"-33" in height at the
south end of the driveway, and as depicted on the survey prepared by Stanley J.
Isaksen, Jr. received on January 24, 2005.
This is not a determination from any other agency.
If you have any questions, please call our office at (631) 765-1892.
Sincerely,
AI~2 JÁ -¡_LJ..· 9n..
President, Board of Trustees
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Telephone
i631) 765-1892
To\'v11 Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTHOLD
At the meeting of the Southold Town Conservation Advisory Council held Mon.,
February 14, 2005, the following recommendation was made:
Moved by Doris McGreevy, seconded by Don Wilder, it was
RESOVLED to recommend to the Southold Town Board of Trustees APPROVAL WITH
A CONDITION of the application of ROBERT & EILEEN SCHIAVETT A to Amend
Permit #5664 to include a retaining wall 40' long and between 27"-33" in height at the
south end of the driveway, and 4' wide steps.
Located: 320 Tarpon Dr., Southold. SCTM#57-1-3
The CAC recommends Approval of the application with the Condition the existing buffer
is maintained.
Vote of Council: Ayes: All
Motion Carried
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TERMS and CONDmONS
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The Pennittee
R9BERT II> EILEEH 8CHIAVI!..l.lA
-:..,__ 320 Tarpon Drive, Southold, N Y
A.~ at . ., as
part of the coosideratioo for the IcC".~ of die Permit does aøcIastaod and prescribe to the fol-
IowÜIg :
1. TIw the said Board of Trustees and the Town of SoutboId I« released from IS17 ...cJ
aU damages, or cWms for damages, of suJø arisiøg cIitecdy or indirecdy as . resuk of IS17 o~-
adoo performed pursulllt to dùs pem>It, and the said Ph.. I""" wi1J, lit his or bet own ezre-'.
defend IS17 ...cJ aU such lUllS .¡..;.¡..,.,.¡ by tbI.td parties, and the said rw..h(. .--. full liability
with respect thereto, to the con>p~ esdusioa of the Board of Trusties of the Town of !:nnof.nId
2. That dùs Pe1mit Is' ftIid for . period of 24 moo. width is C<JaWkred to be !be
estimated time '¡equired to complete !be work invohed, but rboaId cirœmstaDces WUTIAt, request
for III exœasion may be made to the Board at a 1ater date.
~. That dùs Permit should be rcWned indeCmitely, or as loog as the said Petmittee wishes
to maintain the structure or project involved, to provide evidenœ to lllyoae coocerned that md1-
orizatioo was originally obtained.
4. That die wodc involved will be subject to the jnspethoo ...cJ approval of the Board Ot
lis agents, lAd noD-c:omp1iance with. the provisiom of the otigi...tI..g app1icatiOll, rœy be CIUSe fOt
revocatioo of dùs Pennit by raolutioo of the said Board.
5. That thete will be DO WtteIsoooble interference with navigation as . resuk of the wodo:
berein ..ithorized. .
6. TIw there oha1l be no interference with the right of the public to pass and npus a100g
the beach between high lAd low water marks.
7. TIw if future openrloos of the Town of Southold require the 1'eIDOftI and/or aIteratioDs
in the location of the wade herein aatborized, or if, in the opinion of !be Board of Tmsœes, !be
work shall cause IID1'e&SODIble oo.ttuaIOCl to free naviguioo, the said PermIttee will be requhed,
upon due notice, to remove or alter dùs .work ot project berein stated without upeoses to the TOWD
of Southold.
8. That the said Board will be notified by the Pennittee ot the ~ of the work md1-
ori:œd.
9. That the Permittee will obtain aU other permilS and CODSeDII d1IIt ma7 be required III¡>-
plemental to chis permit which ma7 be subject to revoke upon faihue to obtain same.
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Albert J. Krupski, preside. .
J ames King, Vice-President .
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
.
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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 II, 2002
Robert & Eileen Schiavetta
615 Oak Neck Road
West Islip, NY 11795
RE: SCTM# 57-1-3
320 Tarpon Drive
Southold, NY
Dear Mr. & Mrs. Schiavetta:
The Board of Town Trustees took the following action during a Regular Meeting, held on
November 20th, 2002 regarding the above matter.
WHEREAS, Robert & Eileen SchiaveUa applied to the Southold Town Trustees for a permit
under the provisions of the Wetland Ordinance of the Town of South old, application dated
October 28th 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
November 20th 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.
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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 Robert & Eileen Schiavetta
for a Wetland Pennit for new dwelling, garage, sanitary system, pervious driveway, swimming
pool and gazebo with the condition of a 50 foot non disturbance buffer be noted on survey
ignoring wetland line .22 so that there is a more consistent wetland line and go trom .21 to .23
across the back comer of the property.
BE IT FURTHER RESOLVED that this detennination 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 pennit issued within six months of the date of this
notification.
[finspections are required, at a fee of$5.00 per inspection (See attached schedule).
FEES: None
Very truly yours,
f1LL..I 9. /~~ Çv
Albert J. Krupski, Jr.
President, Board of Trustees
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Telephone
(631) 765-1892
Town Hall. 53095 Main Road
P.O. Box 1179
Southold. New Yark 11971
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Monday,
November 18, 2002, the following recommendation was made:
ROBERT & EILEEN SCHIAVETTA to construct a single-family dweliing, garage,
sanitary system, garage, pervious driveway, swimming pool and gazebo.
Located: 320 Tarpon Dr., Southold. SCTM#57-1-3
The CAC did not make an inspection, therefore no recommendation was made.
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Pennits & Drafting Unlimited
P.O. Box 743
~attituck,~ 11952
(631) 298-5968 (ph-fax)
email: Ij5968@yahoo.com
August 3, 2002
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Mr. Albert Krupski, Jr., Pres.
Southold Town Trustees
53095 ~ain Road
P.O. Box 1179
Southold, NY 11971-0959
Re: Request for Excavation Dig Per Health Department Procedure
320 Tarpon Drive, Southold 57-1-3
Dear Mr. Krupski:
Mr. and ~rs. Robert Schiavetta are presently involved in a Health Department
review process for location of a proposed sanitary system at the above vacant lot. You
may recall that about July 5, 2002, the applicants submitted a request for an inspection,
which is at this time pending a staking of the house, sanitary area and driveway.
Since that time, Mr. and Mrs. Schiavetta have obtained a new survey, with
Stanley 1. Isaksen, which contains more infonnation. We have arranged for Jeff
Seeman of Coastal Environmental Corp. to visit the site, and it was flagged on July
26th Enclosed are two (2) prints of this map with the additional infonnation.
We are waiting for Mr. Isaksen to stake the corners of the house, driveway and
sanitary system. We will call to confinn when it has been completed.
Would you also please confinn whether or not the applicants may proceed, at
this time, to conduct a dig (excavation) of the soil in the vicinity of the proposed
sanitary location, for the purposes of the Health Department inspection.
Thank you.
Enclosures (2)
cc: Mr. and Mrs. Robert Schiavetta
Sincerely yours,
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Albert J. Krupski, President
James King, Vke-Presidenl
Artie Fostel"
Ken Poliwoda
Peg¡¡y A. Dickerson
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Town Hall
53095 Route 25
P.O. Box 1179
é'."uthold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLl'
August 28, 2002
Mr. John Kowalski
Pennits & Drafting Unlimited
P.O. Box 743
Mattituck, NY 11952
RE: ROBERT SCHIAVETT A
320 Tarpon Dr., Southold
SCTM#57-1-3
Dear Mr. Kowalski:
The South old Town Board of Trustees inspected the above-referenced properiy on Wednesday,
August 14,2002 and determined the proposed dwelling and associated activities indicated on the
survey dated July 30,2002 would require a Wetland Pennit from this office.
The Board grants you pennission to proceed, at this time, to conduct a dig (excavation) of the
soil in the vicinity ofthe proposed sanitary location, for the pnrpose of tile Health Department
inspection.
Ifyou have any further questions, please don't hesitate to call.
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Very truly yours,
flt..LJ (J /c~~. G.~
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Albert.T. Krupski, Jr.
President. Board of Trustees
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Permits Be Drafting Unl.
P.O. Box 743
Mllttituck, NY 11952
(631) 298-5968 (ph-fIlX)
emllll: 1 5968@yllhoo.com
July 5,2002
Mr. Albert Krupski, Jr., Pres.
Town Trustees
53095 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Re: Request for Inspection regarding Determination of Jurisdiction
~~ ~Tarpon Drive, Southold 57-1-3
Dear Mr. Krupski:
We are making an inquiry for Mr. and Mrs. Robert Schiavetta, contract vendees
who are planning to build their retirement home on the above lot. The lot starts at a point
110 feet south of the Main Road and extends 115 feet along the west side of Tarpon
Drive, Southold Shores. An original recent survey is enclosed for your reference.
The surveyor (John Gallacher) has indicated that the property is located 250 feet
from the canal (tidal wetlands) located at the southerly end of Tarpon Drive. Mr.
Gallacher also indicated that he did not view any fresh wetlands on or close to the
property lines and therefore he did not show it on the map. We are making an inquiry at
this time with your agency because the owners want to be sure before proceeding further.
May we ask your inspection and a letter of determination regarding jurisdiction or
non-jurisdiction, in order that the owners may finalize their construction plans for their
new dwelling. If there is a fee for an inspection, please call us at 298-5968 or reply by
email. Thank you.
Very truly yours,
~K:sJ:~ '
[/¡,~::ts & Drafting Unlimited
Box 743
Mattituck, NY 11952
298-5968
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Permits & Drafttng Un!.
P.O. Box 743
Mattituck, NY 11952
(631) 298-5968 (ph-fax)
emall: 1 5968@yahoo.com
July 7, 2002
Mr. Albert Krupski, Jr., Pres.
Southold Town Trustees
53095 Main Road
P.O. Box 1179
Southold, NY 11971-0959
Re: Request for Inspection regarding Detennination of Jurisdiction
320 Tarpon Drive, Southold 57-1-3
Dear Mr. Krupski:
On Friday, we mailed a request to you regarding the above property. Please note
that we inadvertently used 815 as the house number address for the above property. It
should be 320 Tarpon Drive.
Thank you.
Sincerely yours,
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A,bert J. Krupski, President
J' ames King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 1197'1-0959
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SoUTHoLD
Office Use Only'
_Coastal Erosion Permit Applica~
_Wetland Permit Application _ Major
Waiver! Amendmentl~haj/s
_Received Application: 10 "1 Ó·.y"
_Received Fee:$ /J.ø-¡ - I 'B '
_Completed Application 10 I 10 .yl
_Incomplete (
SEQRA Classification:
Type I_Type II_Unlisted_
_Coordination:(date sent) I .
_ CAC Referral Sent: 10 ~l1J; 0 V'
_Date cfInspection: I lö-l
_Receipt ofCAC Report:' ,
_Lead Agency Determination:
_Technical Review: ! I
_Public Hearing Held: III Jv 10 V
Resolution: '
Minor
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Name of Applicant ì2ö\Y d d [lI'('-en ~'IAJ-e.+f-a...
Address (PIS CòJ( N~ ~co.d ) Lœ5rR1f} }j'd-' IJ7QS- ,¡
PhoneNumber:( ) 63/ btol-H43ð-- --:-_) ~
'""olk C~'Y Tn M'P N"mb~ 1000 - 51 - I - ?¡ -;,. ~
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thl<e ~ I ~ 1\0 8 r!4'5í ~ù-k Jb- 1~O íAf2.Po¡J Dn;e
(provide LILCO Pole #, distance to cross streets, and location)
AGENT -NÙNQ..-
(If applicable)
Address:
Phone:
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Board of Trustees Application
Area Zoning:
R 4D
GENERAL DATA
:;20, r~5 S<=¡. F+.
Res; D~JJ --{.cd
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Re::;-; DeJ'\e..-L
Land Area (in square feet):
Previous use of property:
Intended use of property:
Prior permits/approvals for site improvements:
Agency
Date
fJDIJt.
/ 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: ~ Å
Project Description (use attachments if necessary):
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NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES , TOWN OF SOUTHOLD , ~
In the matter of applicant: 1201':MT+ ~ tLleer1 ~'4ve-
SCTMUOOO- ';) ']-1-3
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a
Permit from the Board of Trustees to:
B..WJd dwei\\~ Qrd t'e.kde& ac:hVl-\-Je~
C '.:g Ee A-TT.Adl~ Su íV-e~ j
the property which is the subject of Environmental
located adjacent to your property and is described as
-:;)dü îàíp'Y\ 'Dnv'i
'50 ¡YTt\·o)0I 'S hare_So ( L.ð-f- jt: ~ "
'Sovwld J,Fj, . rv
3. That the project which is subject to Environmental Review
under ChaPt~r 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 w iting.
2. That
Review-.is
follows:
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.
:r--=C-sl.-I f'
~~
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PHONE it:
~ q. 6l-e.e,
OWNERS NAME:
MAILING ADDRESS:
Enc.: Copy of sketch or plan showing proposal for your
convenience.
Ul"i LB·
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Board of Trustees Application
WETLANDffRUSTEE LANDS APPLICATION DATA
Purpose ofthe proposed operations: e es; De oW \ 'f::,~
Area of wetlands on lot:
o
o
square feet
Percent coverage oflot:
%
Closest distance between nearest existing structure and upland
edge of wetlands: _)JD ~R feet
Closest distance between nearest proposed structure and upland
edge of wetlands: '1O'¡- (Jz. - feet
Does the project involve excavation or filling?
../ Yes
No
If yes, how much material will be excavated?I/Cð+/- cubic yards
How much material will be filled? 26ð + / - cubic yards, /I.j. ,/
~JL/-F' -1-/ -
Depth of which material will be removed or deposited4·· 3tf-tl-feet
Proposed slope throughout the area of operations: 20- 30 i +/~ r# ~~
Manner in which material will be removed or deposited:
~/cð~~
~;;tu~ :o~>
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 {v-J-Jards !M~1 ðY¡ ~v., 10+
..
..
11·~6·4 f2lB71- Texf 12
'I PROJECT 1.0. NUMaE~
617.21
Appendix C
Slate Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT 'SPONSOR C I' + 2. PROo(,Ecr NAMí .
o ri + ¿; 'f'€lì ..xAi Iltv'e- +-a. Du..'2- \ I
3. PROJECT LocAnON: ç --L..I_ _ 'd C" r r [II'
Municipality -.:::0 Ù 1 ""-\0\ County -=:Jv;'----+O J---
Sf
4. PRECISE lOCATION (Streel address and road intersecUons, prominent landmarks. -etc., or proviae map)
3d-ó -¡ZU-'pcrr, 'b n v-e , SnTK'\ol& "ShJre.\ ç, vttx:,lc:t. ~_~.
-s-\-v..rt-.v¥:¡ õY\ 'Sov+h SID-e. 0+ To..'r ~ 110 t=T. e:As!{
£1C-re-NOIN(,. 11'5 F'T EA-sr
"f
Rou-k ~
'-
5. IS PAOPO ED ACTION:
ew 0 Exøansion
6. DESCRIBE PROJECT BRIEFLY:
o Modification/alteration
tv4!.uJ du#Llt~ J <::aY\ l-\--o.T1-( <;'1 'S~:])('~~ arcl rclcJeJ Ochúrf;0.
7. AMOUNT OF LAND AF¡::ECTED: S 9' .
Inillal1y 0 ......"Çcres / Ultlmatel... 3000 F-r acres ~e Œf'd 'Sarnt+ar
3. WilL - O?IJSEiJ A.CTION COMPL':' WITH ëXlSTING ZONING OR OTHE~ EXISTING LAND USë: RESTMICïIONS?
Yes 0 No If No. descnbe brleily
s.¡~J.e.ftVI
9. '''HAT IS ?RE3EST LA/":ù IJSE IN VICINITY OF PROJECT?
~ldenUal U,!ndus:rial 0 Cûmmerclal
De:¡c:ibe:
o AgricUlture
U ParklForesUOoen S03ce
LiOlher
11.
¡D. DOES ACnON INVOLVE A P!:AMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHeR GOVERNMENTAL AGENCY {FEDERAL
STAr~LOCAL ?
!Zfves DNo If yes. r¡st 3gencY(5)and,permiUaøprDV31$ I 1\. f¡~ ~._--.l.
tv Y 'S. D.f::c. / '"Sù F'¡::cJl¡¿ C~y ~ --r-o ~V,
, , Bu: Id I "'1 [)Q.pf- I IOWn I I"--Vç e S
Does ANY ASP)!'CT OF THE Acnou HAVE A CURRENTLY VAUD PERMIT OR APPROVAL?
DYes· K2f No U yes. list agel1cy name and permiUapproval
~rdl n~ '
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12. AS ~ RESULT OF PROPOSED ACTION WILL EXISTlNG.PERMIT/APPROVAL Ñ~':WIAE MODIFICATION?
0,,, DNo a. / IC6- b k.......
I CERTIFY THAT THE INFORMATION "R IDEO AeOvE IS TRUE TO THE 3EST OF MY KNCWlEaGe
1?o bvv+ + £: \>,?eý1 ~~*èC··
'pplicanllsponso, n;mo. - ~. xi!: .
$Ignal"o, .71 ñ-l~,7 Jl.~~.L:. ~dI;::;
0,,", Jo1J.~I~?.
I
If the action is in the CO<Jstal Area, and you are a state agency, complEte the
Coastal Assessment Form be;ore proceeding with this a~sessment
OV::R
?Atiï H-=N'JlRC~IMENI~' 'SSES3MENT ,-:-:) ':Ie G::r.::ie~e8;Y .~g:e!1C"
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.t .·~o. i .1ii!q':H:ve :,ac:.3.r:;'
.Tlay Oe sucersec!!!t.:: =y ~ncl~er ,nvolveo açenc"f.
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0:::1. ~-,usllnr;¡ ilr t:::uallt'(, ;¡urtac~ or ·:¡rQunawale~ .::uallly ~r ::uantlty. .10lse ,e'/eIS. ~x!s~ nq :.a:fic ::ar:erns. ~oli.d .vas~e JrCCl:c:;::;:n Jr JI5=::
;Jotenual fer ~ros¡on. =riilnac;& or :Iooc%inq JroClems? ::"o¡plaln :lflerly:
cz.. A~sthe!lc. iqnc:.llturiil. lrc:1aeoloqlcal. .1IS'OrlC. :lr other .1at:.Jtat :lr CUltur:!.1 ~e50urC25: or .:.ommunlty :lr :\etC;:"Iccrnooo c~;;:rac:er" ~claln ~.
'->. '/e~~latton or :auna. :Isn. ~r:el fisn or 'Nllallfa ,>ùec:es..:>lqmiicanr :1aoitals. ::Ir :Mr~3{e!"led,:::Jr ~ncançerea ::cec:es? Sl:clam 'Jriðlty:
~. ..\ ccmmunlt·('Si c!xis:mr;¡ ;)lans or ·~oals as attlc:ally aQooted. ar a cnange in use or intensity ot use 01 lanCl or other natural resources? Explain :::r
'--.
C5. GíQWln, s:uoseouem :evelooment. ::Ir relatea ac:!vlues likely to "Je .nauceo :iy 'ne :rcoos~o ac:ion? :..xolaln oneilv.
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':3. '_cng :erm. ;¡nol'1 'erm. ::.smulal¡ve. ::Ir ütMer '!rfec:s not IdentlfÍea In C~·"::5? ::XiJlaln ,;mefl'(.
'::U'':er :moac:s ·Inc;..c:nç :::-:ançes In 'J5e of ~nher ~uanHly ,r :y¡:;e or ~nergYJ? ~:ilô.ln ::(lerly.
'J. 5 :'"~E;:¡E. :;A :5 -;-,ë~Ë _:!<:=:L::' -:-0 5E. ·:;::;tH;:¡avE?S·( =!EL..-\ -;-E::J :-0 ?0T:;:.'H"!':"i.... "':'':1J=::1.52 ::.'IVlFìCNME~JT:'L .~.:Pl1.c-;-:;?
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?"'RT III-DETERMINATION OF SiGNIFICANC::: 1'0 ~e COffioleled ~y Agency)
INSïRUCi10NS~ ï=or e3C:'I aaverse ~ffect identified acove. aetermine wnether It is sucstantial.large. ;mcorunt or otherwise signliic
:.ach ~itec': s:1ould ~e assessed in connection 'Nlth Its fa) '5êtting (i.~. urban or ;1Jral); (b) ;Jrooability at occ::J.;õing; (C) duration'
irreversibility; (e, geogracnic .>coce; ana (f} magnltuce. It necessary, add aUac:"!mentS or reference sUPlJoning materials. ~~sure
~XClana{IOnS c:::ntam sufficient deIal1 to snow that all :-e!evant adverse impacts have been identified and a.de~Ua[2 Y aCCressec.
C;'eCK ~his JOX ;f 'fOU {lave identifiea ene ':Ir ..nore ~oteri(ian'llarçe or significant aC'I2rS2 imD2c:s WhIC;l ,'.1A'~
oc:ur. Then :Jrcceea airec:ly ~o :he I=ULl =..l,F =inOlor ¡::;reoare .3. positive- declaraticn.
_ C~ec:< ~his ~ox ¡¡ you :-Jave de!ermmed, JaS2d on the informatian and analysis above and any succorti:lC
doc:...¡menta[!cn. ~n2t :he 'Jrocosea ac:io:1 WILL ~~OT result in~r:y sIgnificant adverse 9nvlrcnmemal !mcac::
AND JreVlce ço ;¡itaC:1r.ten(s 3S necessary, {he ~e3.sons supconing ttllS determination:
......,".. " _,,~U ~\;"nçl
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. 10..: 01 -<,·~oon~IOI'" Urrlc~r
;1\;n..IUI!" JI -<":<COI'1"OIe' ':'r:'(~r ... _~.!Q ........:n(y
~.>;:,....:'JI'! )1 r",:,"J,J¡~' ·rr .;,;:~r...n{ ,~m '..:~OO(\"OI~ .)rr,c<,n
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?AM.ï 11_:::NVIRC~ M=¡·. ·SSES.:'Jï ,-:") ~~ c::r.-:::¡~~eo :y A;.
.:.. :::CES ..:.C";;C~ :::;(CE'=':J ':'NY ., :~S' 7¡-,;::::E's¡",;CLJ:N oj ~P'C??. .:I:";:.ï :i:ì.·:~ ;, (es.
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3. 'NIL~ ..:..C7:C:"l .=1E·:::':"'=. :'::CROIN~7ë.'J .=l.EVIE'N':'S .~Q;C·J'OE::J =,:;::1. 'JI'IL.S72J ...:..C:7:CNS- iN :3 .\I"(Ç:=.R. ~.Q,¡;7 '5:,3i'
:TIav '::Ie sucersece-.:: =.v ~nctï:er .n"'olyea ac;enc'l.
--
=:JcrOLnate :f1e re"'lew
:roces.s 'lna 'Jsa '~9 ~¡...!L:... :::~,...
:t ·~o. 1 .,eç.3.t:...e ~~c:ar",
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C1. =-tlstlng llr ,:uaI1t,. :>urtac:! Of .¡founOwaler ;:uality 7Jr '::l:anuty. "OLse ;e',ets. :!x!s:mc;; :~aífjc: ::anerns. ;¡:Oll~ ·...as;e JfCCl:c:;~n Jf JIs.::;::
:JotenUal fef ~ros on. :::r3.lna¡;a Of :loQ(~inq JrOClems? =-~claln Jrlerly:
cz. ~esthe!lc. aC;;rlc::..lttural. 3.rC:1aealoqIC3.I. :lIs;onc. Jr :Jther .,at:Jral Jf c:wtur31 ~esourc::!s: Jf :.:Jmmunlty :::If "eu;i'lccrnooa c:-:arac::er? S'tclatn ..
v-J. '/eçelatton ~r :auna. :Isn. 5r.ellfisn or "llallla soecle'S. 51gmiicanr :'IaOllal:1. ~r :hre3[e~ed or ~ncanc;erea ~c@c:es? S1:cla.m ~rlðrly:
~. A c:::mmumty's existing ~Ian.s or ~oals as oHlc:all., adooted. or a cnange in use or intensity or use ot !ana or :Jlher natural resources? Explain ;:..
':5, Growlh. sucseouem ~evelocment. ::¡r relatea ac::...ltles likelY !O be ,nauc~o :::IY 'he ::rccosea ac:ion? S:.':lIalO Jrreilv.
.
:5. '_cng :erm. 3nort :er::1. ':;Jmulalive. ~r <3ther '!rfec;s not ¡ce!1ufie<z in C:·,:S? :::.1:)laln :merly_
O:[~ef moac:S ·jnc:.JC:rH; ::::ançes 'n 'Jse of ~~Iher quan1l!Y ~r :vçe or ~ne~qy ? St:H';'JR ::rrefl·,.
oJ. 5 :'":--!!::='E. 'JR .S . ¡-,¡:;::iE :_:~E:.::" :-0 3E. :~j' T;:¡GvE.:¡S" =!E!..,Jr.7E:J 7"0 .=tOTË:'l' !;..... .:..::;vl.::::!SE ::::-IVIRONMe ,;"L ..·.:P~C..37
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?"RT III_DETERMINATION OF S¡GNIFICANC~ ,To je comDleted oy Agency)
INSïRUCilONS: For ~3C:1 aaverse 2tfec: ¡dentified al:ove. determine wnether It is sucstantial. large. ;mcortõnt or otherwise signitic.
=2.c:1 ~ifec': S:1ould ~e 3ssess~ in c:Jnnec:ion 'Nlth its {a) 5etting (i.:2. urean or ~ural); (c) ,Jrooacllity of oc:::~g; (c duration·
irre'/ersloilHv: :e) .Jeogracnic .5coce: ana (f) magmtuce. If necessary, aad attac:lments or reference supporting materials. =:lsure
~xclanations ccntam suftic:ent :jerall to snow that all ~e!e'.Iant adverse impacts nave been identified ana adeGUately accressec.
ç:'ecx ;hls :cx ¡í 'fOU have Icemified 'Joe or onore ~oteri[iall'l rarçe or significant 2C'lerse imoac~s 'NnlC:1 ~.1A·!
oC:::..Jr. Then :>rCC¿20 üirec:I'I to :he ,==ULL ::.:l.F 3.na/or preaare a positive- aeclaraticn.
_ C~ec:< ~his :::ox :i 'IOU ì'lave de!ermined, ::Jased on the information and analysis above and any siJooon;nç
coc:Jrr:enta[lcl1. :ì1a¡ ;t':e :>roo05eo 3.c~icn WILL :JOT result in~('1Y Slgnific3.nt adverse envlronmenral imcac::
AND .:>rCVlce ::n ;i:7.3.c:1menrs 3S necessary. {he reasons supconing rms deTermInation:
"'",,,~ 11 _"..0 \1;~nC",
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;,U",?I ~",oon~,O'''' 01"r:~r
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ArPLt~AN'l'
TRANSACTIONAL DISCLOSURE FORK
The Town of Sou~hold's Code of gthics prohibits conflicts of
interest on the part of town officers and employees. The
purpose of this form is to provide information which can
alert the town of possible conflicts of interest and allow
it to take whatever action is necessary to avoid same.
YOURN1I.HBIR(JþErR.r:;~ / VE;f-
Last name, first name,
you are applying in the
other entity, such
the other person's
NATURE 01 ArPLI~A'l'IONI (Check all that apply.)
. : ';ì¡)!~,
. : ..¡:.~, .;'~H.'.: .!:,~'
.. .
Tax grievance
variance
Change of zone
^p'p~~al of plat
gxe~ption from plat or official map
other ,/' ./ )
(If "other," name the activity.) ì-cl}ð~6 ¡pe'¿M,T(wGTt..Jç
.1,
Do you personally (or ~hrough your cö~pany, spöun@, sibling,
parent, or child) have a relationship vith any officer or
employee of the 'l'ovn of Southold? MRelationshipM includes
by blood, marriage, or business interest. -Dusiness
interest- Meann a busineos, including a partnership, in
vhich the tovn officer or employee has even a partial
ovnership of (or employment by) a corporation in vhich
the tovn of ricer or employee ovn" more than 5% of the
shares.
YES
NO
/
If you ansvered uYES,· complete the baiance of ~h!ø torm and
date and sign where indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant)
and the town officer ør employee. Either check t~ê
appropriate line ~) through D) and/or describe in the space
provided.
'- j
The town officer or employee or his or her spouse, sibling,
parent, or child is (check all that applY)1
11.) the owner of greater than 5% of the shares of the
corporate stock of the applicant (when the applicant
is a corporation),
B) the legal or beneficial owner of any interest in a
noncorporate'entity (when the applicant is not a
corporation) ,
c) an officer, director, partner, or employee or the
applicant I or
D) ~he actual applicant.
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Board of Trustees Application
County of Suffolk
State of New York
E I L~f1,/ ScA+t,¿-r¿ift(
RDbe,zI.5¿ /'1/1 ¡/£ // ~
BEING DULY SWORN
DEPOSES AND AFFIRMS TIIAT HElSHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND TIIAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF IDS/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 TIllS
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.
~~~
1/th-.. ¿d¿J~
1 SIgnature
SWORN TO BEFORE ME THIS ~ g DAY OF [ & ,20\5?..
DAVID J. VOLPI
Notary PUblic. S'ale or New York
o~~;::'~:~ ~;-~/.~;·:~;:::~O~
coo""!,~o,, E·pros --21¿ß--! D~
OL'I 2 9 i. .