HomeMy WebLinkAboutTR-6079 •
James F. King, President ~~OF SOUjyO Town Hall
Jill M. Doherty, Vice-President ,~O l~ 53095 Route 25
P.O. Box 1179
Peggy A, Dickerson # * Southold, New York 11971-0959
Dave Bergen G Q
Bob Ghosio, Jr.~` ~ ~O Telephone (631) 765-1592
~~~COO~ Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
February 14, 2007
Shannon Goldman
212 Grand Street #3A
New York, N.Y. 10013
RE: SHANNON GOLDMAN & DEBORAH MCKEAND
8605 SOUNDVIEW AVE., SOUTHOLD
SCTM# 59-6-27.2
Dear Mr. Goldman:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, February 14, 2007:
RESOLVED that the Southold Town Board of Trustees grants AOne-Year Extension to
Permit #6079, as issued on February 16, 2005.
This is not an approval from any other agency.
If you have any questions, please do not hesitate to contact this office.
Sincere
o~`['!~
James F. King
President, Board of Trustees
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Albert J. Krupski, Presid~ • Town Hall
UFFO( 53095 Route 25
James King, Vice-President $ ~C
O P.O. Box 1179
Artie Foster Gy Southold, New York 11971-0959
Ken Poliwoda C
Peggy A. Dickerson N Z Telephone (631)765-1892
Oy ~ Fax (631) 765-1366
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BOARD OF TOWN TRUSTEES
TOWN OF SOLITHOLD
RE RE UIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
YOU A Q
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR APRE-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
/ '/z constructed
V Project complete, compliance inspection.
.K
..r.•. _.r
Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
,t? O, p~ Feb. 16, 200
PERMIT NO.. 1..... DATE:.......... `r
.s
' SHANNON GOLDMAN AND DEBORAE{.,.~.0$$Q1QIT .
ISSUED TO
,~u#l~nri~a#inri .
Pursuant fo the provisions of Chapter 615 of the Lews 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 "REGULATING AND THE PLACING OF. OBSTRUC~NS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS.F$OM
LANDS UNDER TOWN WATERS;'.'. and in accordance with 'the
Resolution of The Board adopted et a meeting held on Feb.: I6, 2005
and in consideration of the sum of >i.25.Q...oa..... paid by
Shannon Gold?Rff.n...amd._Debo.X~h..Mckaand._...._
of ....souehold......_ N. Y. and. subject to the
Terms end Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permih the fogowinq:
Wetland Permit to construct asingle-family dwelling and garage with the condition of
gutters and drywalls to contain roof runoff, a 50' non-disturbance buffer to the pond, a hay
bale line at the 50' buffer line to be left in place and all as depicted on the plan surveyed
by John Ehlers and last dated February 14, 2005.
aq in accordance with the detailed specifications as presented in
.the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes ifs Corporate Seal to be affixed, end these pprresents to
be subscribed by a majority of the said Board as of th'n date.
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TERMS end CONDITIONS
~ p Shannon Goldman and Deborah McKeand
ag1d10g at New Ynrk Itl, y,, rs
tlE the to~aatian for fhe isssuna Of the Permit don ottdetstand and ptescdbe to the fd-
1. Thu the add Board of Ttuaees and the Town of E;watold ate released from nay std
all thuaaget, oc dalnts for daauges, of alts raising. dherdy or iodlrectly u a rtak of any open
atloa perEom[ed pmswat-~,iada l!ad.'{he laid t?e;mitree w1tl,, at 6h .a her own tecpeasq
defend ..ny sad a8 such saits'Iaiaated h7 tbitd fatties, and the aid arsutna Eou llablllq
whh «spetx dterao. fo-ebeyaomplete acdadoa of ate Baacd of Tasoees of the Iowa of Southold _
t Thu this Petmi[ it valid for a period of 24 tnos. whidt !s dOras1dettd m 6e the
estimated time required m complete the work involved, lntt thaald dzdmt~stanta vvarram, request
for as e>rendon may be made to the Board a[ a leer date.
3. That this Paton should be retained Ltdefidtdy, or u lgng u the aid Permiaee wldta "
to'tnaintain the setuemre or pmjea involved, to provide evideaa m anyone ooacamd that amh-
cobaFdoa was originally obtained.
4. That the vtodc lavolved will be subject [o fhe inspocdon and appears! of the Soatd or
its agents, sad noaeomp0ame vviat the provisions of the otigioadag appliudoa, any be cause for
revocation of this Petnflt b1 tesolutlon of the said Board.
S. Thu there will be ao uotauomble iaterEerenoe with aavigadoa u a tesuh of the wodc
htseta atnhorhbd.
6. Thu theft dull 6e m iaoafaeaoe with the right of the publk to pass sad repass aloo¢
the beach between high sad low wader marks.
7. Thu if future aperatioas of the Tovm of Southp(d tegtdro thn removal attd/a alaraaaot
in the Iocadon of the wodc herein a~nthodred, or Ef, h the opinion of~e Board of Trasxes, the.
vrodc-shall ause mrnsoaable obstmmoa to free aavigaaon, the raid Peomittee vtill be regairod,
ttpoa slue ootia, to remove or alter dJs work a project herein staged without eat ro tLe T'own'
. of Southold
8. That the Bald Board will be twdEled by the Pemilttee of the oompledon._of the work troth-
othed.
9. Th4t the'Pumitta. wlli abuin .B odter permits and axixati shag taq 6e regniced aap~
plemeaal ro thk permit which may be abject to terolre npoa failaee ro obnin came.
James F. King, President -``~OF SOUjyO Town Hall
Jill M. Doherty, Vice-President ,~O 53095 Route 25
Peggy A. Dickerson P.G. Box 1179
Southold, New York 11971-0959
Dave Bergen G Q
Bob Ghosio, Jr. ~0 ~ ~O Telephone (631) 765-1892
Fax (631)765-6641
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BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
February 14, 2007
Shannon Goldman
212 Grand Street #3A
New York, N.Y. 10013
RE: SHANNON GOLDMAN & DEBORAH MCKEAND
8605 SOUNDVIEW AVE., SOUTHOLD
SCTM# 59-6-27.2
Dear Mr. Goldman:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, February 14, 2007:
RESOLVED that the Southold Town Board of Trustees grants AOne-Year Extension to
Permit #6079, as issued on February 16, 2005.
This is not an approval from any other agency.
If you have any questions, please do not hesitate to contact this office.
Sincere
James F. King
President, Board of Trustees
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•
THIS IS NOT A PERMIT
New York State Department of Environmental Conservation
Notice of Complete Application
Date: 10/24/2005
Applicant: SHANNON GOLDMAN
Facility: GOLDMAN PROPERTY
SOUNDVIEW AVE SCTM 1000-59-6-27.2 ~ ,
SOUTHOLD, NY 11971 - '
Application ID: 1-4738-03472/00001
Permirs(s) Applied for: 1 -Article 24 Freshwater Wetlands
Project is located in SOUTHOLD in SUFFOLK COUNTY
Project Description:
The applicant proposes to construct a single family dwelling with porch, deck, driveway, and sanitary system.
The proposed project is within 65 ft. of State regulated Freshwater Wetlands. The property is located on
Soundview Ave., SCTM 1000-59-6-27.2, Southold, Town of Southold.
State Environmental Quality Review (SEQR) Determination
Project is not subject to SEQR because it is a Type II action.
SEQR Lead Agency NOne Designated
State Historic Preservation Act (SHPA) Determination
Cultural resource lists and map have been checked. No registered, eligible or inventoried
archaeological sites or historic structures were identified at the project location. No further review
in accordance with SHPA is required.
Availability For Public Comment Contact Person
Comments on this project must be CAROL A FARKAS
submitted in writing to the Contact NYSDEC
Person no later than 11/14/2005 SiJNY @ STONY BROOK BUILDING 40
STONY BROOK, NY 11790-2356
(631)444-0364
CC List for Complete Notice
Chief Executive Officer
SHANNON GOLDMAN
PATRICIA C MOORE
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SOFFO(,~
Albert J. Krupski, President Q~~ CQG Town Hall
James King, Vice-President 'y~ 53095 Route 25
Artie Foster y - P.O. Box 1179
Ken Poliwoda Z Southold, New York 11971-0959
Pegg} A. Dickerson ~ ~
yifJO aQ`' Telephone (631) 765-1892
1 l~ ~ Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
February 16, 2005
Building Inspection Services
606 Fox Hill Drive,
Baiting Hollow, New York 11933
RE: SHANNON GOLDMAN AND DEBORAH MCKEAND
8605 SOUNDVIEW AVENUE, SOUTHOLD
SCTM# 59-06-27.002
Dear Mr. Scholz:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday February 16, 2005 regarding the above matter:
WHEREAS Building Inspection Services as agent for SHANNON GOLDMAN AND
DEBORAH MCKEAND applied to the Southold Town Trustees for a permit under the
provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the
Town of Southold, application dated December 27, 2004, 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 February 16, 2005 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 standards set forth in Chapter 97 of the
Southold Town Code,
January 20, 2007
Board of Southold Town Trustees
Town Hall
53095 Route 25
Southold, New York 11971
RE: Permit No. 6079
Issued: Feb.16 2005 to Shannon Goldman and Deborah Mckeand
With reference to the above referenced wetlands permit (copy attached), I am
submitting a request fora 1-year extension.
If you have any question, please do not hesitate to contact me.
Best gar
~nnon
Shannon Goldman
212 Grand Street # 3A
New York, NY 10013
tel. {212) 925-0711
email shannonCa?rockvillegictures.com
„
Fps
z • •
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,
RESOLVED, that the Board of Trustees approve the application of SHANNON
GOLDMAN AND DEBORAH MCKEAND to construct asingle-family dwelling and
garage with the condition of gutters and drywells to contain roof runoff, a 50' non-
disturbance buffer to the pond, a hay bale line at the 50' buffer line to be left in place
and all as depicted on the plan surveyed by John Ehlers and last dated February 14,
2005.
Permit to construct and complete project will expire two years from the date the permit
is signed. Fees must be paid, if applicable, and permit issued within six months of the
date of this notification.
Inspections are required at a fee of $50.00 per inspection. (See attached schedule.)
This is not a determination from any other agency.
Fees: $100.00
Very truly yours,
~ ~ .
Albert J. Krupski, Jr.
President, Board of Trustees
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f~' Board Of Southold Town Trustees
SOUTHOLD, NEW YORK ?
(oO1°I DATE: .'un
PERMIT NO. ~
i
ISSUED TO ti~l ' 'ri:~~; , ,r~~ , , I •~~.;6 ...,n_ _ _
~ ~ix#l~ari~tt#tnn .
` Y Pursuant to the provisions of Chapter 615 of the Lows of l
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 "REGULATING AND THE PLACING OF OBSTRUCTK3NS
IN AND ON TOWN WATERS AND PUBLIC LANDS end the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;' end in accordance with the
Resolution of The Board adopted at a meeting held on ~~`'I'.' -I ~i'0'
F
end in consideration of the sum of S?'O•(1(1 paid by
Shunn~>> tl.~dm~in,-,ln5l._Uc '~y i_..Ih,,. `1cJ.ceutid... ~
t
€ of .._`"'t I'".!'{_ N. Y. and subject to the
Terms end Conditions listed on the reverse side hereof, ~
of Southold Town Trustees authorizes and permits the following:
Wetland Permit to constnict asingle-family dwelling and garage with the condition of
' gutters and drywalls to contain roof runoff, a 50' non-disturbance buffer to the pond, a hay
~ bale line at the SU' t uffer Ilne to be left In place and all as depicted on the plan surveyed
by John Ehlers and last dated February 14, 2005.
e8 in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trupstees here-
by causes its Corporete~ea) of the s~deBoard es of this d ~.to
be subscn'bed by a maj ty
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MAILING ADDRESS:
PLANNING BOARD MEM)~S P.O. Box 1179
JERILYN B. WOODHOUSF. `.o~~OF SOUjyolo Southold, NY 11971
Chair OFFICE LOCATION:
KENNETH L. EDWARDS ~ ~ Town Hall Annex
MARTIN H. SIDOR va ~ 54375 State Route 25
GEORGE D. SOLOMON ~ ~ ,O (cor. Main Rd. & Youngs Ave.)
JOSEPH L. TOWNSEND O~O ,.a Southold, NY
a ~'~UIY 1
Telephone: 831 766-1938
Fax: 831 786-3138
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
To: Ruth D. Olivia, Chair
Town of Southold Zoning Board of Appeals
From: Mark Terry, Senior Environmental Planner v~
LWRP Coordinator
Date: June 20, 2006
Re: ZBA File #5887 (Chamews) Y
SCTM#1000-83-1-12 LWRP Reach: 2
The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of
Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based
upon the information provided on the LWRP Consistency Assessment Form submitted to this department,
as well as the records available to me, it is my recommendation that the proposed action is
INCONSISTENT with the denoted following LWRP recommendations and Policy Standards and
therefore is INCONSISTENT with the LWRP.
The LWRP emphasizes the prevention of the potential degradation of water quality in Great Pond stating;
"One aspect of this is the need to reduce the flow of
podlutan[s to the surface waters of Goldsmith Inlet,
Autumn Pond, Great Pond and Lily Pond, not to mention the wetlands and drainage swales that feed these
water bodies. Two types ofpollutant sources are of great concern: that of stormwater runofffrom public
and private property and that of
poorly-sited or malfunctioning on-site wastewater treatment systems. "
"Yastewater treatment is a major problem where the lots are non-conformin
ice, particularly if the lots
are on the water's edge. As the value of waterfront continues to increase (be this sound, lake or pond
front),
the pressure to upgrade and expand existing structures on undersized lots may result in increased levels of
pollution to surface and ground waters. "
Additionally, the proposed action is inconsistent with Policy 6 for reasons stated below.
Policy 6 Protect and restore the quality and function of the Town of Southold ecosystem.
6.3 Protect and restore tidal and freshwater wetlands.
A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees
laws and regulations for all Andros Patent and other lands under their jurisdiction
1. Comply with Trustee regulations and recommendations as set forth in Trustee
permit conditions.
The proposed residence on SCTM # 59-6-27.3 is sited at 80 feet form a freshwater wetland: a
minimum seuaration distance of 100' is required aursuant to Chanter 97. Please require that the
annlicant amend the aoulication to meet the above uolicv.
Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written
determination regarding the consistency of the proposed action.
Cc: Board of Trustees
- pgUFFO(,~ •
Albert J. Krupski, President ~~V CO~
James King, Vice-President Town Hall
Artie Foster ~ ~ 53095 Route 25
Ken Poliwoda y P.O. Box 1179
Peggy A. Dickerson ~ • ~ Southold, New York 11971-0959
?f~ ~aO~ Telephone (631) 765-1892
~ Fax (631) 765->~69@'tj~.;~
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
To:_ /Y1?Ch~,z I Sc~,~lz re° Shun~~~ CtitdMu ~ b ti,
D~ w~ ~1 ~ Ke
Please be advised that your application dated- c=. ~1,
reviewed by this Board at the regular meeting of~ b, I 2 OLD has been
following action was taken: and the
( Application Approved (see below) _ 'A a~ w,~l ~~j ~Je 141 'h,
f~ ~Ictn
Application Denied (see below)
Application Tabled (see below)
If your application is approved as noted above, a permit fee is now due. Make check or
money order payable to the Southold Town Trustees. The fee is computed below
according to the schedule of rates as set forth in the instruction sheet.
The following fee must be paid within 90 days or re-application fees will be necessary.
COMPUTATION OF PERMIT FEES:
1`r('ct~ f7Alc 1nsFrc-f,a., q S0. ~ )
't~nN' ~InS~~c~~„~ 9SU OG ~IpO
~i.% .a as -os
TOTAL FEES DUE: $ ~ 00 ~ ~ D
SIGNED: U.~-I' / •
PRESIDENT, BOARD OF TRUSTEES
h~O~~SUfFO(,~-coGy
Telephone ~
1631) 761-IS92 °y Z Toun Hall
n~ 13095 Route 25
~ ~ P.O. Bo.t 1179
y?J~l ~ ~aQ`' Southold, Neu fork 11971-0959
CONSERVATION ADVISORY COUNCIL
TORN OF SOUTHOLD
TO: Southold Town Board of Trustees
FROM: Southold Town Conservation Advisory Council
DATE: January 11, 2005
RE: Recommendations
A meeting of the Southold Town Conservation Advisory Council was held Tues.,
January 11, 2005. The following recommendations were made:
DISCUSSION AND RECOMMENDATION OF WETLAND PERMIT & COASTAL
EROSION PERMIT APPLICATIONS
Moved by Don Wilder, seconded by Tom Schlichter, it was
RESOLVED to TABLE the Wetland Permit application of SHANNON GOLDMAN &
DEBORAH MCKEAND to construct asingle-family dwelling and garage.
Located: 8605 Soundview Ave., Southold. SCTM#59-6-27.2
The CAC Tables the application because the wetlands line is inaccurate. The CAC
recommends a full wetlands review.
Vote of Council: Ayes: All
Motion Carried
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Building Inspection Services
Construction Management Building Inspections
Construction Consultant Permit expediter
New York State Building Code and Zoning Consultant
Certified code enforcement official
Cell (516) 909-9145 Fax (631) 369-7324 E-mail mschholzi?2uiaoLcom
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Boazd of Town Trustees Fe ruazy 3, 2005
Town ofSouthold -Town hall
53095 Route 25 S~~t.o,tl la:n
Bo:~rtl of Trust?es
Southold, New York 1 1971-1 892
Subject: Amendment to Wetlands Permit for Shannon Goldman and Deborah McKeand
Deaz Sir or Madam
We would like to amend the wetlands Permit submitted for 8605 Soundview Ave, Southold, NY,
SCTM # 1000-059.0-06.00-27.002, to include the annual trimming of the phragmites, common
reed, located on said property. The phragmites will be trimmed annually to a minimum of 1.00
foot for the entire length of the coastline for the said property.
Attached please find a copy of a survey indicating the azea of trittuning.
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Sincerely
Michael J. Scholz
Authorized agent for
Shannon Goldman and
Deborah McKeand
Albert J. Krupski, President • ~SUFFO(~C •
Town Hall
James King, Vice-President ~'Z`~ Gy 53095 Route 25
Artie Foster p ~ P.O. Box 1179
Ken Poliwoda ~ ~Z Southold, New York 11971-0969
Peggy A. Dickerson ~ ~
~Q a0t' Telephone (631) 765-1892
1 ~ Fax (631)765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD 1 1
Office Use Only ' Ne.~ f -EO S~^"'Y
Pu
_Coastal Erosion Pem,it Application ~''b-. u( ~ ip-c dv, 5krv~,
_GWeHand Peratit Application Major ;Minor _
Waiver/AmendmentlCha eS ~0 ~ ~ ~ {'f C(r-
eE~d Application:) 2-) a'~`~C~~j 1 7_ ~ L ~
!ReceivedFee:$ ~SL7- r~"
_C-ompleted Application ~ ~ ~ ~ ~~,.,r) r~ ~ ~ jep-F~~ IJU' ~c•c ~
_Incomplete D V l5
_SEQRA Classification:
Type I_Type II_Unlisted_ ti
_Coordination:(date sent ~ ~ L i
CAC Referral Sent: 1 ~ ~ Ot
--Plate of Inspection: / / 7 0
Receipt of CAC Report: Southold Town
Lead Agency Determination: Beard of Trustees
_Technical Review:
~Gblic Hearing Hzld: % OS
Resolution:
Name of Applicant Shannon Goldman & Deborah McKeand
Address 212 Grand St. New York, New York 10013
Phone Number:( )
Suffolk County Tax Map Number: t000- 059.0-06.00-027.002
Property Location: aFOS o,nd ~ w Avenue (west side)
~,,~v~~?
(provide LILCO Pole distance to cross streets, and location) Cv~7D`
~7
AGENT: gu; 1 d; ng__r_ns_pPrt; on Se,-vices Michael J Scholz
(If applicable) -
Address: 606 Fox Hill Dr., Baiting Hollow, New York 11933
_ Phone:~T 6) 909-Q1A5
.Board of Trustees Applicatn
GENERAL DATA
Land Area (in square feet): 23, 277 Sq. ft.
Area Zoning: R-40
Previous use of property: Vacant (R-40 )
Intended use of property: Single Family Dwelling
Prior permits/approvals for site improvements:
Agency Date
x 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:
Project Description (use attachments if necessary):
Single Family Dwelling with Garage
max. 4 Bedrooms
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: Single Family Dwelling
Area of wetlands on lot: 0 squaze feet
Percent coverage of lot: p
Closest distance between nearest existing structure and upland
edge of wetlands: ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: S p feet
Does the project involve excavation or filling?
x No Yes
If yes, how much material will be excavated? ~ cubic yards
How much material will be filled? 0 cubic yards
Depth of which material will be removed or deposited: 0 feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
movement of Existing Soil for Placement of Single
family dwelling foundation
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):
none
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: Single family dwelling
Are wetlands present within 100 feet of the proposed activity?
No X Yes
Does the project involve excavation or filling?
X No Yes
If Yes, how much material will be excavated? 0 (cubic yards)
How much material will be filled p (cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
movement of existing soil for placement of single family
dwelling foundation - 50' from Great Pond"
PROJECT ID NUMBER 617.20 • SEOR
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
PART 1 -PROJECT INFORMATION ~ UNLISTED ACTIONS Only
( To be completed by Applicant or Project Sponsor)
1. APPLICANT/SPONSOR Shannon Goldman 2. PROJECT NAME
& Deborah McKeand
3.PROJECT LOCATION:
Municipality Southold county Suffolk
4. PRECISE LOCATION SVeet Addess and Roatl Intersections. Prominent lantlmarks etc -or orowde map
8605 Soundview Ave., (west side)
5. IS PROPOSED ACTION : ® New ? Expansion
? Modification /alteration
6. DESCRIBE PROJECT BRIEFLY:
Single family dwelling - Aprox. 1750 Sq. ft. footprint
7. AMOUNT OF LAND AFFECTED:
InitialtY acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
®Yes ~ No IF no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
Residential ~ Industrial ~ Commercial ?ggriculture ~ Park /Forest / O en S ace
P P ~O[her (descnbe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Fetleral, State or fowl)
Yes ?NO IF yes, list agency name and permit /approval.
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Yes ?No If yes, list agency name and permit /approval:
7rr2''~~A''S A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
LJres ~No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant /Sponsor Name
Dale
SignaWre
If the action is a Costal Area, and you are a state agency,
complete the Coas[al Assessment Form before proceeding with this assessment
PART II -IMPACT ASSESSMENT To be tom leted b Lead A enc
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NVCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF.
Yes ® No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NVCRR, PART 617.6? If No, a negative
declaration may be superseded by another involvetl agency.
Ves ® No
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, 'rf legible)
C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, existlng traffic paltem, solid waste production or disposal,
potential for erosion, drainage or flootling problems? Explain briefly:
No - Erosion control/containment will be used during construction
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or wmmuniry or neighborhood characteR Explain briefly:
No
C3. Vegetation or fauna, fish, shellfish or wiltllife species, significant habitats, or threatenetl or endangered species? Explain briefly:
No
C4. A community's existing plans or goals as o~cially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly:
NO
C6. Growth, subsequent development, or relatetl activities likely to be inducetl by the proposed action? Explain brie6y:
No
C6. Long [enn, short term, cumulative, or other effects not identified in C1-C6T Explain briefly:
No
C7. Other impacts (inclutlin than es in use of either uanti or t e of ener 7 Ex lain brief)
No
D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA CEA ? If es, ex lain bdefl
Yes ® No
E. IS THERE, OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain:
Yes ~ No
PART III • DETERMINATION OF SIGNIFICANCE (TO be completed by Agency)
INSTRUCTIONS: Foreach adverseeffectidentified above, determinewhether it is substantial,large, importantorotherwisesignificant. Each
effect should be assessed in connection with its (a) setting (i. e. urban or rural); (b) probability of occurring; (c) duration; (tl) irreversibility; (e)
geographic scope; and (i) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations wntain
sufficient detail to show that all relevant adverse impacts have been identifietl and adequately addressed. If question d of part ii was checked
yes, the determinatlon of significance must evaluate the potential impact of the proposed action on the environmental characteristics ofthe CEA.
Check [his box if you have identified one or more potentlally large or significant adverse impacts which MAY ocwr. Then proceed tlirectly to the FUL
EAF and/or prepare a positive declaration
Check this box if you have tleterminetl, basetl on the information antl analysis above and any supporting dowmentation, that the proposed aclio
WILL NOT result in any significant atlverse environmental impacts AND provide, on attachments as necessary, the reasons supporting Ihi
tle[ermina[ion
Name of Leatl Agency
Date
Print or Type Name o Responsible icer in Lea Agency
Title of Responsible Officer
Signature of Responsible Officer m Leatl Agency Signature of Preparer (If di Brent from responsible o ter)
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
Shannon Goldman & Deborah McKeand SCTM# 1000-059.0-06.00-027.002
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a Permit from the Board of Trustees
to: Build single family homes
2. That the property which is the subject of Environmental Review is located adjacent to
your property and is described as follows:
3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or
97 of the Town Code is open to public comment on: .You
may contact the Trustees Office at 765-1892 or in writing.
The above-referenced proposal is under review of the Board of Trustees of the Town of Southold
and does not reference any other agency that might have to review same proposal.
OWNERS NAME: Shannon Goldman & Deborah McKeand
MAILING ADDRESS: 212 Grand St.
New York, New York 10013
PHONE
Enc: Copy of sketch or plan showing proposal for your convenience.
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
Shannon Goldman 212 Grand St.
Deborah McKeand New York, New York 10013
STATE OF NEW YORK
COUNTY OF SUFFOLK
Shannon Goldman ,residing at 212 Grand St. New York
New York t 0 n 7 3 ,being duly sworn, deposes and says that on the
day of , 20 ,deponent mailed a true copy of the Notice
set forth in the Boazd of Trustees Application, directed to each of the above named
persons at [he addresses set opposite there respective names; that the addresses set
opposite the names of said persons aze the address of said persons as shown on the current
assessment roll of the Town of Southold; that said Notices were mailed at the United States Post
Office at ,that said Notices were mailed to each of said persons by
(certified) (registered) mail.
Sworn to before me this
Day of , 20
Notary Public
i
CIARELLI & DEMPSEY
K~kru c. cLaRELLI ATTORNEYS AT LAW
PdiRIQi A. DEMPSEY
737 ROANOKE AVENUE
P.O. BOX Ogg
RIVERHEAD, NEW YORK 11901
(631) 369-5100
Facsimile: (631)369-5132
January 14, 2005
Board of Trustees 2 ~ Q ~ I
Town of Southold D 15
53095 Route 25
P.O. Box 1179 JAN ~ ~ 'j "J
Southold, New York 11971-095
Re: In the Matter of th A licati so(t, T steel
McKeand pp on oldman and Deborah
Dear Sir or Madam:
Enclosed please find the original Affidavit of Posting in reference to the above-
mentioned matter.
If you have any further questions please do not hesitate to contact me.
Yours tnxlY, nn
PA RICIA A. DEMPSEY
PAI . 116
Enclo e
Board of Trustees Application
County of Suffolk
State of New York
Shannon Goldman
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT OR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HIS/FIER 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.
Signature
SWORN TO BEFORE ME THIS DAY OF ,Zp
Notary Public
•ard of Trustees Applicati~
AUTHORIZATION
(where the applicant is not the owner)
I. C'laman7- rr, s residing at 40635 County Rd. 48
(print owner of property) (mailing address)
Sou hold M v i do hereby authorize Building Inspection
(Agent)
Services - Michael J. Scholz to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
~t
(Owner' signature)
8
Dec-22-04 10:1OA Rockville Pictures 212 ~6 1747 P.O1
lJlC 2G U9 UI' ~ IP m~an~ n~.~~~a~
board of Trustees Application
ZtZ- ZZ4-~~'1~
A1f180RIZATZON
;whcerlle the applicant is not the owneri
I ~ ~~~~^~~S2cv„~~_- residing at ZI Z, (~pv;.fl ;~i i . _
(rrinr. owner of property) (mailing address)
f~,..~ Yor.~s~~ tp0 t~ _ do hereby authorize ~~e1 S Se.~,p
tAaent.l
~tis~~- VU\C.ec to apply for permit(;i from the
Southold Board of Town Trustees an my behalf.
i ~G
x_.
(~:#rrier's signature)
Ky t ~-s~j ~~g- 43zsr,
s
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
wn of Southold s Code of Ethic orohibits con0i of interest on the Dart of town officers and emolovees The otwose oI
~ r information which can alert the town of oosstble con9tets of mterest and allow rt to take whatever aaton is
~~~rv to avoid same.
YouRNAME:Shannon Goldman & Deborah McKeand Represented by
(Last name, fast name, Middle 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.)
Building Inspection Services - Michael J. Scholz
NAME OF APPLICATION: (Check alt that apply.)
Tax grievance Building X
Variance Trustee }jr
Change of Zone Coastal Erosion
Approval of plat Mooring
Exemption from plat or official map Planning
Other
(If "Other', name the activity.)
po 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 interesP means a business,
including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation
in which the town officer or employee owns more than 5% of [he shares.
YES NO X
If you answered "YES", complete the balance of this fomt 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 applicanNagenVrepresenta[ive) 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 alf that apply):
A) the owner of greater than 5%of the shares of the wrporate stock of the applicant
(when the applicant is a corporation);
B) the legal or beneficial owner of any interest in a non-cotpota[e entity (when the
applicant is not a corporntion);
C) an officer, director, partner, or employee of the applicant; or
D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
None
Submitted this day of 200
Signature
Print Name
Form TS I