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HomeMy WebLinkAboutTR-5936 . . James F. King, President ,Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE.CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1 st day of construction Y. constructed / Project complete, compliance inspection. tJ Ie - &1& /0 6j(~~ James F. King, President .rill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 01l3C Date June 7, 2006 THIS CERTIFIES that the sin~le-family dwel1in~ At 1300 Leeton Dr., Southold Suffolk County Tax Map # 58-2-1 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/1/04 pursuant to which Trustees Permit # 5936C Dated 6/24/04 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a single-family dwelling The certificate is issued to PAUL ORLICK owner of the aforesaid property. ro<~ Authorized Signature . . 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 COASTAL EROSION MANAGEMENT PERMIT Permit #5936 Date: June 24,2004 SCTM#58-2-1 Name of Applicant/Agent: None Name of Permittee: Paul Orlick Address of Permittee: 30 Stern Court, Farmingdale, NY 11735 Property Located: 1300 Leeton Dr., Southold DESCRIPTION OF ACTIVITY: To construct a single-family dwelling and shift footprint of home 6' towards the water and cantilever rear deck into CEHA with no footings in coastal erosion hazard area, and as depicted on the survey prepared by John C. Ehlers last dated June 1, 2004. Permit to construct and complete project will expire two years from the date the permit is signed. SPECIAL CONDITIONS: (apply if marked) _ Bluff restoration through a re-vegetation plan is a necessary special condition of this permit. _ A relocation agreement is attached hereto and is a necessary special condition of this permit. _ A maintenance agreement is attached with application and is a necessary special condition of this permit. . ~ tJ. 4- ....1.: 9-- Albert J. Krupski,' Jr. 7 President, Board of Trustees AJKllms . 2 . . Telephone (631)765-1892 Town 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 Tuesday, June 15, 2004, the following recommendation was made: Moved by Don Wilder, seconded by Doris McGreevy, it was RESOLVED to recommend to the Southold Town Board ofTrustees APPROVAL WITH A CONDITION of the Coastal Erosion Permit application of PAUL ORLICK to construct a single-family dwelling and shift footprint of home 6' towards the water and cantilever rear deck into CEHA with no footings in coastal erosion area. Located: 1300 Leeton Dr., Southold. SCTM#58-2-1 The CAC recommends Approval of the application with the Condition there is no disturbance seaward of the house. Vote of Council: Ayes: All Motion Carried r 1 11 ! . , L . " '., 9~ ~. ~, ~~ ~ -, ~.' J, ( > . . ' - Iii , ¡Ii 'r i! lit :-:J. Iii ¡r !),-, Iii. It I', ,l' i ii 'I II' ~ i ' la I I. ~ I~ .- . 'I. ili ---<II i .,.:, I, dr :1" ¡II ~ I <>-Z I . ,._""" ~_'--T"'- , ~ " , ! / -.¡ II! '/1 I P"I;>, / / / I!!I_~ ~. ,I ~;¡ I ''Z¡ ";':::~J ~ "~.... " ¡'"r ", / ~;i I! ',>,¡¡: . r ,.........."'... , ---2?--¡- ..----!!l-- . / WI !. ..' o+~ o. ,,?~?~ . , , / .,.' I ~I /~;j/ / ,I I / , ,¡ '", ~ ci:-I;If'W'f~·-_. U~ -.." > i CO :. § L.() t tit 0 ¡ ~ ª ~ " iI ~ i! Ii 1(' ;Ž~ .....>- "'.."- 8j~ :::¡ ~- ;rf- ~. . 15- . ~f:.j -~~ g~I è ·1·' &~ 'II; ¡"I' g ¡:~ ~ · "lil lIu¡ !;~ I tl Illhl! ¡;@\ ill,!! Iii!! H., I iill, "'Ii¡ 1111 Iliiil o . _ ~ ~ . i iilll ~ I ! I I ~¡ I¡III JIlU_ ill! 18". I Iii ',1 ; i j II ¡¡ I~' I : 3 . . :I II: 'I " III I~i\ ' Iii ! II ~ I ¡¡lie _n..a...zc " ~" "< , ~.:-"~" Q~.v / / , f e , , ! i ...", + . . 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 April 1, 2004 Mr, Paul Orlick 30 Stern Court Farmingdaie, NY 11735 RE: 1300 LEETON DR., SOUTHOLD SCTM#58-2-1 Dear Mr. Orlick: The Southold Town Board of Trustees reviewed the survey prepared by John C, Ehlers dated March 10, 2003 and determined the proposed single-family dwelling and porch to be out of the Wetland jurisdiction under Chapter 97 of the Town Wetland Code and Chapter 37 of the Town Code, Therefore, in accordance with the current Tidal Wetlands Code (Chapter 97) and the Coastal Erosion Hazard Area (Chapter 37) no permit is required, Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary or seaward of the coastal erosion hazard area as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction and Coastal Erosion Hazard Area, which may result from your project. A line of staked hay bales must be installed along the coastal erosion hazard line before any activity begins, However, any activity within 100' of a Wetland line or seaward of the Coastal Erosion Hazard Area would require permits from this office, This determination is not a determination from any other agency, If you have any further questions, piease do not hesitate to call. Sincerely, J~~'.f 9· ~. ~. Albert J, Krupski, Jr., President Board of Trustees AJK:lms · 71.64 5733 P.01 645627 _ 1 r /, /; /'- '.' -..,. .' (- l.... \1 --I t . , '--í~ "' / (, iIu- ----- - '( f- 1./ s:- (e c~ S; , &t U J.Q{ ~ ~! -k.. 1./ I S I -1- fD ~ "-"< 0 V'-r J.,,,-';) , "; Òe c£ t.e', fL¡ NO hoTí-~s D-1 /300 Lêe-ro¡J Ì)i-/"~ oS c-rf1#- --:Šf5 - ;;2 - / - /l1 7 C-e (( fA o/Vt. -;q- <5 ' \5:1 ¿) t Z(f/ - 37 (! I 'p- 7 ð~ i.J-fe. ~ 7'" 11,( (_,- t1 I¿'~ -- [ô),1E Ii: G: I I¡IJ IE ~ \r\ì MAY - h 2004 1l!dJ ~C<Æ,I:: 7 ð'c Southold Tow. Board of Trustees I / 'a;{-J) S¿r- n ¡' - // ' ~Æ.·£Æ ~Ut<.Vt:T Ur t-'KUt-'t:K IT 5IìUA"'T'E= SOUTHOLD TOY-IN= SOUTHOLD SUFFOLK COUNTY, NY SURVEYED 03-10-03, ~[fft'&.~Jt6t~ .p~XI"-04 1000-5B-2-1 ~ MICHAEL ARNOUSB OOMMONWEALTII LAND 'lTIU! INSURANCBCOMPANY ~ \o,(\Ò \0 \....O(\~ \~~. ~~) ",':c"-' . I:I."~ ().\of\0 _nI1'~;J \\f\ß ~ ~br"JlJ\J I ('1,\0 ' Ò 00~ CBRTIII'IIID TO: / / / / / / / / / / / / / / -- / / , / / / ", / / / / / /, , / / / / / / / / / / _1' / / / / 0 / / / / / ~, / / / / / / , \(,e ¡O(ð~· (\ 'rI0 -- 0"'\°/ ~~ ,-- v% %0- - / 'S> v "'() --\"Z. , c -;.-- ~-";'. /() C __ ->-"- ,"0 -- "7...:i ""'c ,'& ....,.-; / / / / ~ \fI;J) ,.....::: .. ..¡tlf> ...~~) ,....... I ~....::¡[t&\\:......" 1-d'" ........ ...æle\;~~-"'-"'''' 1.af'Ø ... -(eX \Ü ¡"""~ / ~ / () co? ? -- _/ \S' 'c) a ....., ~ç,. () -r 03'6 %1- (2) ~ J? '\', S~ ,03 ()'S> ?-.;.. 0->- ~() ()/ 03 % () .. ý~ ~ \~' / / r " / " / / '0 , Y 0"""""""- o _~e.(.¿.y oo~o "0 . ~y/o~~ _ // / ~: / '" ,v/ ,/- .---. / , j ..--0 "~ ._____o------.~S·"JfJ , /0 ~A,'!) / \ o~ ~ -- '0.----- / / ~ / --------------- .:",-,&' ..' '~~ ~ '" " 1- ___/--.. / / " ~JI:}l;:¡~ / / / / / / -- -ý' I / --/---ý, / / / / NOTES, " - ..---~ ,........~," NE'" :', ,-,- _t?'. t.. VI{ e"" "" . ~."'.. -..-.-...... ()". ~" "". -' '.:.Lr ~"- I~L... "'- .' ,"." -\" 1..rr(J::.~ -"_ 71- , ./ "-;:' -.:-' :.- :::-"~ê'''\ (" I ~' ~ ~.'~ ):'1 ',". ",,0 ~.- r .. A .'1t '. _~:L?\~~~~q "ANUj;) ""'''- .....Q,""",'~" ,,,~_,'''O" ,.. "<In."""'~ . ,~.~., ..",,~ Oft,.."")" ,<-ftn...., "'''~ .~,.....-' 'c" . " ..o,,,,,,,"~,- .~<"o.- ,","; '"-,.,.~ ".",.-. 2 ." "ft ''''~ '''''. "'m~ E.',.:."''''·~ o PIPE FOUND ELEVATIONS REFERENCE N"'VD' 2C:¡ EMA FLOOD ZONE ANNOTATED FROM FIRM AP # 3b103COI54 '" DTD MAY 4, IqqB COASTAL EROSION HAZARD LINE ANNOTATED FROM DEC PHOTO # 5b-5bb-B3 SHEET B OF 4'1 DTD B/2q/BB .-~., ,,,,ns, ,,~~..~ "'-'J'''-'''',c. "'.~' .~",.", ~,".,.. "'"J".","' "'~ ,~'.... ..~.,, .-.-. ""..."s" 'so' .'~" "" .-"'. ",.-ft." " "" .~, 0" ~ AREA = 1/:>,221 S,F, OR 0,31 ACRE SUFFOLK COUNTY ~ATER AUTHORITY MAIN IN STREET .~""""~""-' ""oo,~" "S'ft.,.. ''0/'', ,c_" "". .."ø, ~"" ","S O"'""" £ .,.-·.,.-""",ø h'".'-''' ~.. .....'3 ~"o~ 0' ~..",-",-~ '0" L,"", """"",¡o """'I',M "" "... _~ "or'_ ~''''~ ....."'-",,..,... o' F,~'...,;. ""'" L""" ~'"'~P-' So.... ¿""""""~,,. or",,, r,~ """ '<' ",ø 0""'"'' ''''' .....""~ ".ø .....-.ø, '. "r"O"".~ """ 0' ".. ø..""''' <0 "... ,,,·ø """"'''"''' ~=.ø_~ør_ ,," "''''-''''J """ 'ønd~", """"'''''' '..,..~ ........"" ...., '" ...-~. "",,,,,,...ft' <>' "'" '.'~~~ "..'....,,~" ~øroo.,<~ ,,~....,..~ '"' """"...-"",.. '" ""~"'~""' ~..".,~... JOHN C. EHLERS LAND SURVEYOR 1"= 20' 6 EAST MAIN STREET RIVERHEAD, N.Y, 11901 369 8288 Fax 369 8287 N.Y,S, LIC. NO. 50202 'l~ , I REF,\\Hp server\dIPROS\03-128.pro J '1DTT ;:tI::" '.... SURVEY OF PROPERTY SITUATE: SOUTHOLD TO¥'{N: SOlJTHOLD SUFFOLK COUNTY, NY ~~' SURVEYED 03-10-03, PROPOSED HOUSE 02-18-04 AMENDED 06-01-04 (i ~ !b!b!I .". ~ = 0 ~ C~ ,.$ = .". .gë ~o- !b!b!I I Õ- £SC :z: ~'E O~ g ::::> <nO .. -;> !b!b!I ~ SUFFOLK COUNTY TAX # 1000-58-2-1 ð 00~ ~~ \()(\ð \0 \,....O(\~~ CERTIFIII!D TO: PAUL ORLICK COMMONWBALTII LAND 'l'ITI..B INSURANCE COMPANY \çj)~' v-\.0) Þ-~' . I!."~ ()\of10 _nI"I'~;;J \\f\0 ~ ~b,''.J''\J I l'l.\0 / / / / / / / / / / / , / /'. / /- / / / ~. /' / / / / / / /, / / / o / ~, / / /'::: /,...". ....... // -:?, ," ..-- .....- ////:;/';';~- -8--.. ,./....... //.....-- ,:,,·-,,3---..~ 0./,... //......- .1£'---.-,..-.....--- ;:- ---.:-<./ -' - - " ~-;;:::'-""":.. ;,.. I ___ ~- -:::.-...p..... ;:-..... I~ -¿ ~ .. - .. -.. .""'" .-;...,.../ .... .. 'v" ~Ò· -... .'.::-...!!Y................ -~-/ ~..'" _._ 7,................ ...... /' ~'( /' .....~..;:-I:;..:,.:;... 'J .............-- ..'..,...- --- .................--- -;.....- /,,0- ~,#'""'--- --- ....... --- ... -- ...... .....// -- '............- / / / - -,. / / ,/ / / /^ / / / , V'~ ,::} rS- -:, / ,~ Þ ~'\ C) ","1- / / / , ~ '>~ C) -'f'. -::::() () -. SO ., ? 1""\3', -. -<;~ ~->- ;'~ / f:¡) ~ leo' '\..... .... r _JJ.,ft;. ...', \'!I) ...., t,r _ ';,lo _ - ' ~~""......'" ' (e\ \~) .......... .Jt. _ _ - - -z.on" .. (&\ \\) ,1P""~ I I I ~ () CO, í 09, 10 ê:>- Cè -1 :3 6. Ç{l- ~ ()~ / \ -- \~. / ~ / Ç!>< -0, -zq, ~3 ()0 CO -. ô.:;: ./ ........-0 ,/ \-e,("v~u .".oo~o \. ~Gn£\' \'/\çj)"'" '(.,,, 9....-.4 ~ 9, () \ o)~ \ ~Q~$if,;¡;~ ~.........-o .~© ~ ~ ,/ / , \ß'Jd\O~ / / / / NOTES. / / / o PIPE FOUND " - ELEVATIONS REFERENCE N6VD' 2'1 FEMA FLOOD ZONE ANNOTATED FROM FIRM MAP # 36103COI54 6 DTD MAY 4, 1'1'18 COASTAL EROSION HAZARD LINE ANNOTATED FROM DEC PHOTO # 56-566-83 SHEET 8 OF 4'1 DTD 8/2'1/88 PROPOSED PORCH TO BE CANTILEVERED I^IITH NO SUPPORTS TO BE I^IITHIN 100' OF LON6 ISLAND SOUND AREA = 16,221 SF OR 0.31 ACRE SUFFOLK COUNTY I^IATER AUTHORITY MAIN IN STREET \'2."P' / / , r" ~ . , '_'.~ -. :,"'1 -C,-,o,-,.,,.,".-,- - . _.. ,,<.,__,-~~ - > --,~- e ~"C ,.>~. n:";,; '~,:: -" '" ~.- .. r ,,'0, - õ _' ,,-.~, coo. "0" --,-, , ,pr·'" . ,-,- ;--.~" -"".,-, , ,,~ ," ., .'~~ JOHN C. EHLERS LAND SURVEYOR N.Y,S, Lie. NO. 50202 0RAPHIC. SC.ALE ~ 6 EAST MAIN STREET RIVERHEAD, N,Y, 11901 369-8288 Fax 369-8287 1"= 20' ------------- REF.I\Hp server\d\PROSI03-128.pro --- ------- - . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson . Town Hall 53095 Route 25 P,O, Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ..-c;;:tal Erosion Permit Application _Wetland Permit Application _ Major _ Minor Waiver/Amendment/Changes .-Received Applici!ion: "/1101( -1teceived Fee:$ èL.~1:) -eompleted Application (¡, J I J 0\( _Incomplete _ SEQRA Classification: Type I_Type Il_Unlisted_ _ Coordination:( date sent) ..eAC Referral sent:~~ ......Date of Inspection: _Receipt ofCAC Repo : _Lead Agency Determination:_ Technical Review: ""I'iiblic Hearing Held: "/J" lot Resolution: rö)IECEIW/C 0 IJ11 JUN - 1 2004 Sealhold TOIIII Board 01 Trustees Name of Applicant Cøu~~ fí¡Yr1'1/'¿ AJ¡ Phone Number:(S'¡ð· ~ - S--S- Suffolk County Tax Map Number: 1000 - 5' R - d - I Property Location: / 3 D () J..(, e 'io IV 'D í / [)~ L'!Cò lot# <6 +f (provide LILCO Pole #, distance to cross streets, and location) Address ':) 0 .- ill 3 ~ S~rrJ AGENT: (If applicable) Address: Phone: · . Board of Trustees Application GENERAL DATA Land Area (in squarefeet): /01 () D21 / Area Zoning: R - ¿j D Previous use of property: V A...C~ Intended use of property: <::;/v1(cÇJCh1A,' If ,~ Prior permits/approvals for site improvements: Agency Date ~ prior permits/approvals for site improvements, Has any permit/approval ever been revoked or suspendedpy a governmental agency? ~o Yes -- If yes, provide explanation: Project Description (use attachments if necessary): B vJcL (;·"10 fie fÍU7,¡1t ~ 'f: sh,(í :Jhyr 1Y ¡h...c<- 6 k<-T 1;;vJfk~S {t,c wPrt€A- C(M;, i;/e ~ fe- a¡¿ 1:x c/e ~ (\)(;¿JtaJ (lo<:,-ðV-, INl'tít ¡J()~ßotrÆ/40' ;'^) C'(ì[~ C/~(~ ~~, I . . Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: SI1/A jìMIJG'5~ l~ bffe-+----1¡,t.AJ~h , 1 f ,-' f~ . L,J fA.., ðvt-' Ú i·/ (¡~ L t1A- D c )J !ð. iz.~ e rv..s:¡ ~ Au",- 1/"1 VJ J hv-t;'yvI.¡S ¡ÌJ Cvtu+tJè ~I~ ~. Are wetlands present wit\j.in 100 feet of the proposed activity? '~NO Yes Does the project involve excavation or filling? V No Yes If Yes, how much material will be excavated? (cubic yards) How much material will be filled? ( cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting £rom implementation of the project as proposed. (Use attachments if necessary) ~ ~I iYÕV\ML.tA iJ ~(/i/'i5 Þ.e~, fÁtÞ-~ ~~~:= ~..~ ~t µ:;~r:;/~;~;:;~ 1 f~e( 17rpC(A/'l/~ ÛkU (J PROJECT ID NUMBER r . PART 1 - PROJECT INFORMATION " APPLI!:JT ¿;O 3.PROJECT LOCATION: STATE SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 617.20 APPENDIX C ENVIRONMENTAL QUALITY SEQR REVIEW 2, PROJECT NAME < Municipality 4. PRECISE s e 5. IS PROPOSED ACTION: County LOCATION: Street Addess and R~ Intersections. Prominent } ?:> C! 0 _ ~ e e:{6 ¡J (Jr-¡ 'I/~ /0 I ~New o Expansion D Modificati, CCf(~~~ &U.~ 6, DESCRIBE PROJECT BRIEFLY: C, 6 tJ S-=[;-evC'( S"/ ,tJt / G ¡:-cl\ßVI I! R.e.A~D~c-t will e.;:ft-ud /Ìv' 7. ûVLA.. vJ 1'-f1-, JJO /DC'f: i;!;ç U4?tL LIJ,I( BQ.. úlA.,'fí/~ v.vcdJ 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WlLL~POSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~es 0 No If no, describe briefly: ~ IS PRESENT LAND USE IN VICINITY Q1 Residential D Industrial D Commercial OF PROJECT? (Choose as many as apply.) DAgricu,ture D Park I Forest I Open Space o Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal State or Local) DYes ~ If yes, list agency name and permit I approval: 11.00ES DYes ANY ASPECT OF THE ACTION HAVE A CURRENTLY VAllO PERMIT OR APPROVAL? ~ If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? []v es No Applicant I CERTIFY THAT /íHE INFO;MAT)ON PROVIDED ¡Sponsor ame 1"/10/ G'Rþ~é ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Signature Date 6/1/ð Y If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . PART II - IMPACT ASSESSMENT (To be completed bv Lead Aaencvl A. DOES ACTION EXCEED ANV TYPE I THRESHOLD IN 6 NVCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF. DVes DNO B. WILL ACTION RECEIVE COORDINATEO REVIEW AS PROVIOED FOR UNLISTED ACTIONS IN 6 NVCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. D Ves DNO C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1 Existing air qualify, surface or groundwater quality or quantity, noise levels, existing traffic pattem, solid waste production or disposal, potential for erosion. drainage or flooding problems? Explain briefly: I I C2. Aesthetic, agricultural. archaeological, historic. or other natural or cultural resources; or community or neighborhood character? Explain briefly: I I C3. Vegetation or fauna. fish. shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly' I I C5 Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I I C6, Long tenn, short term, cumulative, or other effects not identified in C1·C5? Explain briefly: I I C7. Other imnacts (includinn chan as in use of either Quantity or tvnP. of enemv? Exnlain briefly: I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? {If yes, explain briefly: I D Ves D No I E. IS THERE, OR IS THERE LlKELV TO BE, CONTROVERSV RELATED TO POTENTIAL AOVERSE ENVIRONMENTAL IMPACTS? If ves exolain: D Ves DNO PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes, the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Pnnt or 1 ype Name of Responsible Officer Ln Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) . . Albert J, Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P,O,Box1179 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 ___~~\.__(:)_(_\!l~"'___________________________________ COUNTY OF SUFFOLK) ST ATE OF NEW YORK) I, )H(A( O~ I,'cl AFFIDAVIT OF POSTING , residing at 30 - S/-(O,) {'O()rt;"¡:C?fP77.dt being duly sworn, depose and say: That on the 10 ~ay of ::(ClIJe.. , 200 ,I personally posted the property known as I ~ 00 - '?~f.:fðì....,Ì)r/(/<- 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...It'\,l.li'Si ~l.lO~ d4 l~þO\J ... on or db ~ . (J1'f\. Dated: ((, Ill{ l Ùl¡ Sworn to before me this \ i day of\.llAt.J200 If ~~ Notary Public ANN ELIZABETH GAY NII'-<y Public, State of New Vork No. 4753140 Quallfted In Nassau Coun1y CommissIon Expires June 30.~" . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: /v1Arj R 0 jVLð .:J 0v\I}'\ 0 M D /10 7 A I (¡,'V\.JO R'1M¿tht.o Address: ! ?Jù :5' - L e e1 éh br S,) u tit? (j: , '¡J l' ) I'i.ll } / D I- .:;. ec avJ..- So!.-' f1 J.,¡'I I . J'-""l r ~CI T't I U '"1 / 1f{3 J (' I 3 ¿ - "57 - l/2 SI T3~.s,~ / Ui . 113"/ STATE OF NEW YORK COUNTY OF SUFFOLK ¡}/JI.A. (OR/t'cA ,re~idingat 30- j (-erlll CT{: FÎJrÚ/1/t'vJ.ldc/'v.7 11 ì 3 ~ ' bemg duly sworn, deposes and says t at on the ,/ day of ::rï.j/..)(. _ ,20~ 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 South old; that said N s were mailed the United States Post · Office at Cy 1 í1plt iÌ L , that said Not' es ere mail eaT of said persons by · (certified) (registere¢) mail. ~ ..., Sworn to before me this / ~ . Dayof lÍ u.NJ ,2~ ~C(~ Notary blic ANN ELIZABETH GAY Notary Public, State of New York No. 4753140 Quellfled m Nassau County Commission Expires June 30. ~ r') · . Board of Trustees Application County of Suffolk State of New York Po t'lj C) 1:./ (' cf- 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 HlS/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 REPRESENTATlVES(S), TO ENTER ONTO MY PROP Y TO INSPECT THE PREMISES IN CONJUNCTION WI W OF S PLICATION. ~ Signature SWORN TO BEFORE ME THIS l DAY OF ,20 !251 ~ 0\ßQ Not ry Public LYNDA M. BOHN NOTARY PUBLIC, State of New York No. 01 B06020932 Qualified in Suffolk Countxn Tern. Expires March 8, 20 .U..f . . APPLICANT/AGENT~PRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Drohibits conflicts arinterest on the Dart arroW" officers and emolovees. The Dumose of this fonn is to nrovide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: it. (Last name, first Dam, ddle 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.) NAME Of APPLlCA nON: (Check all that apply,) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity,) Building ± Trustee Coastal Erosion Mooring Planning Do you personally (or through your company, spouse, sibling, parent. or child) have a relationship with any officer 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 partia( ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% o~ shares. YES ___ NO / (fyou answered "YES", complete the balance of this fonn and date and sign where indicated. Name of person employed by the Town of South old Title or position of that person Describe the relationship between yourself (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) 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): A) the owner of greater than 5% of the shares of the corporate stock of the applicant - (wben the applicant is a corporation); _B) the legal or ·beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer. director, partner, or employee of the applicant; or _D) the actual applicant. DESCRIPTION Of RELATIONSHIP S~bmitted t~~i oft tJ~ S'gnature . C ~'t. Prmt Name 2001 fonn TS I