HomeMy WebLinkAboutTR-5617
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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.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
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15\ day of construction
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_ Project complete. compliance inspection.
Nancy A. Kongoletos
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TERMS and CONDmONS
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The Permittee
N~n("'~r A Knnønlptnc
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residiag It 57958 Main Road. Southold, N. y~ as
part of the coosideration for the issuance of the Permir does UI1dentaød and pæscribe to the fol-
~:
1. That the Aid Board of TIUSteeS and the Town of SoutboId ale released from ID.'f and
aU damages, "" claims f"" damages, of suhs arising dirccdy "" iadirecdy as a result of ID.'f o~'
atioo performed puouant to this petmit, and the said p.. ...~ wiI1, It his or her own elf t. ....
defend ID.'f and aU such adts· Inlft.-.l by third parties, and the said F . 1'1'" .......... full liability
with respect thereto, to the COf"p~ exdusioo of the Board of Trustta of the Town of ~
2. That this Petmit is· ftIJd for a pèriod of 14 mas. whkh is ( QDSPt oW to be the
....-i-ted time requimI to complete the work in~hoed, but ihoa1d circmDstaøces warnat, request
for an exœmion may be made to the Board at a later date.
3. That this Permit should be retained indef"aoitely, or as loog as the said P~ wisbCs
to m.;....¡n the strucatte or ptoject involved, to provide evidence to anyone coocerned that aøch-
orization was originally obtained.
4. That the work involved will be subject to the inspecÞoa and approva1 of the Board or
its agents, and DOn-oomplianœ with the provisioos of the or1gino'¡..g app1iatiot>. r:œy be cause f""
revocation of this Permit by resolution of the said Board.
S. That there will be no unteaSON'ble interfereoce with oavigation as a result of the work
berein authorized. .
6. That there sba1l be DO interlereoce with the right of the public to pass and repess a100g
the beach between high and low water muks. .
7. That if future ~otIS of the Town of Southold reqWre the RII1Oft1 and/"" altendoas
in the location of the work berein authodJ~. or /I, in the opinion of the Board of TmsteeS, the.
work sba1l cause unreasonable obsttuctIOt1 to free oavigatioo. the Aid Permittee will be rcquIæd.
apoo. doe notice, to remove or alter this work or project berein stated without expeases to the Town
of Southolcl.
8. That the Aid Board will be notified by the Permittee Ot the ~. of the work aøch-
orized.
9. That the Permittee will obtain aU other permits and cooseats that may be requimI sup-
plemental to this permit which may be subject to revoke upon failure to obtain same.
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
September 30, 2002
Nancy A. Kongoletos
36 Anna Court
Wading River, NY 11792
RE: SCTM#066-2-2.4
57958 Main Road
Southold, NY
Dear Ms. Kongoletos:
The following action was taken by the Board of Town Trustees during a Regular Meeting, held
on September 25,2002, regarding the above matter.
WHEREAS, Nancy Kongoletos applied to the Southold Town Trustees for a pennit under the
provisions of the Wetland Ordinance of the Town of South old, application dated August 20,
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
September 25, 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.
.
.
2
WHEREAS, the Board has determined that the project as proposed will not affect the health,
safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board of Trustees approved the application of Nancy A. KODgoletos for a
Wetland Permit to build a two story single family dwelling with two car attached garage,
structure will have a wrap around porch to a deck - in ground pool- clear 4 foot wide path down
to water to be covered with wood chips with the condition of a 50 foot non-disturbance buffer in
the wetland delineation line with setbacks to the septic system house shall contain roof run-off
and drywells - drywell for the backwash of the swimming pool
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.
Fee must be paid, if applicable and permit issued within six months of the date of this
notification.
If inspections are required, at a fee of$5.00 per inspection (See attached schedule).
FEES: $10.00
Very truly yours,
/7d J()
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Albert J. Krupski, Jr.
President, Board of Trustees
AJK!cjc
cc DEC
Building Department
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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.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
15\ day of construction
./
% constructed
x
Nancy A. Kongoletos
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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) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO:
N~,,("':r r KQRgsIBts8
Please be advised that your application, dated August 20th,
has been reviewed by this Board, at the regular meeting of
and the following action was taken:
2002
:J~pt'ÇUJLt::.L 25, 2862
(-L..) Application Approved (see below)
(-) 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 fcll~wing fee must be paid within 90 days or re-application
fees "'11.;' be necessary.
COMPUTATION OF PERMIT FEES:
,
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Two Inspecdons
1~,5, 00 each
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TOTAL FEES DUE:
$
10.00
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SIGNED:
tltl..c.· ¥ t). 1&., ,...t' 9,
PRESIDENT, BOARD OF TRUSTEES
BY: (!.~ ~ (£'.1_ -1u.r-
CLERK, BOA~OFJTRúS~Š'
4/98
"
.
.
.
Telephone
(631) 765-1892
Town Hall. 53095 Main 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,
September 23, 2002, the following recommendation was made:
Moved by Drew Dillingham, seconded by Melvyn Morris, it was
RESOLVED to Table the Wetland Permit Application of NANCY KONGOLETOS to
construct a single-family dwelling with two-car attached garage, porch, deck, install an
in-ground swimming pool, and clear a 4' wide woodchip path to access the water.
Located: 57958 Main Rd., Southold. SCTM#66-2-2.4
The CAC Tables the application because the project was not staked properly and there
were stakes missing.
Vote of Council: Ayes: All
Motion Carried
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SUFFOLK COUNTY WATER AUTHORITY
Tir"othy J. Hopkins
Geperal Counsel
Administrative Offices; 4060 Sunrise Highway, Oakdale, NY 11769-0901
(631) 563-0236
Fax (631) 563-0370
September 5, 2000
Richard Lark, Esq.
Main Road
P.O. Box 973
Cutchogue, NY 11935
Re: Application for water service of Deluca
Premises - SCTM No. 1000-66-2-2,2.1,2.4,2.5
Dear Mr. Lark:
Last year your client, Charles Deluca, applied for water service for at the above referenced parcels. Please
be advised that water is currently available for the subject parcels.
This letter of availability is not to be considered an action by the Suffolk County Water Authority as
defined by the New York State Environmental Quality Review Act regulations or a determination that the
parcel is approved for· building. You are responsible for obtaining any other pennits or approvals that may
b~ required for the proposed project. The Suffolk County Water Authority shall not be required to provide
water for the project until all required approvals have been obtained.
This ktter should not be deemed a guarantee of water availability at the time you ",-ish to hook-up and is
subject to recission.
.
\
Please contact the SCW A's Regional Manager in Westhampton at 631-288-1034 for fees and conditions of
service.
Ve.!)::.ll{lly
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Timothy J. Hopkins
.
cc: Hennan J. Miller, Deputy CEO for Operations
Steve Romano, Regior.al Manager
Charles Deluca
Esseks, Hefter & Angel
EXHIBIT )
-
HUG-03-2001 11::'4
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New York State Department of Environmental Conservation
Division of Environmental Permits, Region One
Building 40 - SUNY. Sto~y 8rook, New York 11790·2356
Phone: (631) 444-0365 " FAX: (631) 444·0360
WelMite: www dec.state.ny.us
~
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Enn M" Cfotty
COMI'T'iI,stOneor
LETTER OF NON-JUR!SDICTlON: TIPAL WETLANDS ACT
June 15, 2001
..Mr. Charles Deluca
.Sox 1136
Southold, NY 11971
Re: Deluca Prope~y
Lot #4 in Subdivls;on of Charles Deluca·
57968 Main Road
Southold. NY 11971
DEC# 1-4738-02899100001
Dear Mr. DeL'Jca:
Based on the i~fom1ation ycu have submitted, the New York State Oepartmer";\ of Env:ronme'1tal
\ Conservation has determined that:
T!'Ie portlOr- of your property which is Iccated landward of U",e topographic crest of a bluff In excess of ten
feet in elevation. as shawn on the survey prepared by John C. Ehlers last revised May 9, 2001, IS beyono
the jurisdicticn of Artlcla 25 (Tidal Wetlands).
Therefore, in accordance with the current Tidal Wetlands land Use Regulations (6NYCRR Part 661 ) no
permìt is required under the Tidal Wetlands Act. Please be advised. however, that no construction.
sedImentation, or disturbance of any kind rr.;¡¡y take place seaward of the tidal wetlands junsdic\io:1a:
boundary. as indicated above, without a permit. \t is your responsibility to ensure that all necessary
precautions are taken to prevent any sedimentation or oth6r alteration or di¡;turbance to the ¡¡round surface
or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautlol'ls may
include maintaining adequate war\( area between the tidal wetland ju~isdictional boundary and your project
(i.e. a 15' to 20' wide cons1.ructlon alea) or erecting a temporary fence, barner. or hay bale berm.
Please be further advised that ~hiS letter does not relieve you of the responsibility of oetalnlng any
necessary permits cr approvals from other agencies.
Very truly yours.
~~..~ 2~:>
Reg Evans
pe' t Administrator
s/....t''r-
cc. Permits & Driilf\ing Unlimited
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.
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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
May 17, 2001
Mr. John Kowalski
Permits & Drafting Unlimited
P.O. Box 743
Mattituck, NY 11952
RE: SYLVIA E. DELUCA
SCTM#1000-66-2-2.4
Dear Mr. Kowalski:
The Southold Town Board of Trustees reviewed the survey dated February 2, 2001 anù last
revised April 27, 2001 and determined that the proposed house and garage would have activity
within our jurisdiction.
A permit must be applied for if you choose to leave the house in thc current location. If you
ùecide to move the house further away from the wetlands a lctter üf non-jurisdiction would be
considered.
Please call our of!ice if you have any questions.
Very truly yours,
~(? /~4·Q.
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Albert J. Krupski, Jr.
President, Board of Trustees
AJK:lms
.
.
PERMITS & DRAFTING UNLIMITED
P.O. Box 743
Mattituck, NY 11952
(631) 298-5968 (ph-fax)
amail: Ij5968@aol.com
April 28, 2001
Mr. Albert Krupski, President
Town Trustees
53095 Main Road
P.O. Box 1179
Southold, NY 11971-0959
MAY - , .
Re: Request for No-Permit Determination (lNP) - Deluca
Dear Mr. Krupski:
Supplementing our previous requests for letter of Non-Jurisdiction,
enclosed are revised survey maps for both lots, as requested, to show the tidal
wetland information. The lots are located near Beixedon, along a private road,
south side of Main Road in Southold.
A letter of Non-Jurisdiction is requested for each of the following two
projects as shown :
1000-66-2-2.4 (lot 4) owned by Sylvia Deluca
1000-66-2-2.2 (lot 3)owned by N. Charles Deluca.
Thank you.
Very truly yours,
ìt~
Enclosures (2)
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SURVEY OF LOT 4
MINOR SUBDIVISION OF FOR N. CHARLES DELUCA
51TUA TEl SOUTHOLD
TOWN: SOUTHOLD
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AMENDEIJ 03-0q-01, 04-21-01 r:.:.f6"." .......
SUffOLK COUNTY TAX # ... ..-
1000-bb-2-2.4
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AREA = 18,lbQ Sf OR 1.81 ACRES
ELEVATIONS SHOY"N REfERENCE N6VD '2Q
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SHOY"N Y"ERE ANNOTATED fROM NYSDEC
TIDAL Y"E:TLAND BOUNDARY MAPS
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JOHN C. EHLERS LAND SURVEYOR
, GRAPHIC SCALE
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6 EAST MAIN STREET
RIVERHEAD, N.Y. 1190l
369-8288 Fax 369-8287
N.Y.S. Lie. NO. 50202
REF.I\Hp server\dIPROSIOI-lI6D.pro
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SURVEY OF LOT 4
, MINOR SUBDIVISION OF FOR N. CHARLES DELUCA
SITUATE= SOUTHOLD ~
TOViN= SOUTHOLD /1/))(;[;
SUFFOLK COUNTY, NY ....f';j~/·)(C
SURVEYED 01-08-02, '.'ø\,
PROPOSED HOUSE 08-14-02 "J
REVISED 0'HI-02. O"l-20-Q2 '. .'~õ-...,<-//
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SUFFOLK COUNTY TAX # ... .þ~~~;. ';}
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17
AREA, 18,16"1 SF OR 1.81 ACRES
ELEVATIONS SHOV'lN REFERENCE N6VD 2"1
CR~
~{
·'_~"-,,~,-'·~~r.'._~',.,,. ,,~""",.~ ,_" ",_,~"
..p~~...-r.-;", ~~.~,or..e"".
',"'.-."or =' ""'''~" ,.c-",.,",cr ; =. ,r<.
~~" ~"'''. t'.~'~1 ",- _=..
THE DOCK REFERENCED ON THIS SURVEY IS
CONSTRUC TED OF ONE BOARD 8 INCHES V'lIDE
AND SUPPORTED APPROXIMATELY I FOOT ABOVE
THE !^lATER BY V'lOODEN POSTS
AVERA0E HI6H !^lATER AS SHOV'lN ON THIS SURVEY
IS ALSO THE LINE OF THE CREEK ED6E OF V'lETLAND
.. . .." ,.~' ",r ·"~.r ,~" '" .", '.'·'e,
., ,.,~~;':.,',,~~':=~'-"';:-:_J,;':~ ,-,-:.."~r.~ ''';:;. o,o:,~,__";
-~, "'''~' :,-, 1_,','_"'" ,~.~,. '''1-''" ,,~, Ie"
". _'CO". k~"~'-"" . "- . ." _~ ~'V ,r~~.
,." '~..' ',-"d'_B ¡-- L' , 'io,."_~" """"'~,"
'-'J ~;, ""', _'~~"..,';~,,, ._~~;~,-;: ;:~~'v""
'"'~,.- "A' ", '. ,,~ .",. ,.:;.:';'~;,.
.:' ~>"'"'-'J ,,",'
~ ~""i".~; ., '"",.",0" ..~-.",
.." "'~'n,-~o'A .,,~ ',,,,,,,:_.,,,",,,,",,;~
JOHN C. EHLERS LAND SURVEYOR
-----
6 EAST MAIN STREET
RIVERHEAD, N.Y. 1190l
369-8288 Fax 369-8287
N.Y.S. LlC. NO. 50202
REF.I\Hp serverldIPROSIOl-116I.pro
0RAPHIG SGALE
1"=60'
---------
.
.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Albert J. Krupski, President
James King, Vice-President
Henry Smith
Artie Foster
Ken Poliwoda
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
'.,
\f
¡,
I
_Coastal Erosion Permit Applicati9J1
/Wetland Permit Application _ Major
Waiver/ Amendmen1¡lCh~ng"es,.
~Received Application: g J~It:)~
~eceived Fee:$ ;HY\- ~ J
~ompleted Application 'S' (dOlO '¥
_Incomplete
_ SEQRA Classification:
Type I_Type II_Unlisted_
_ coOrdinatiOn:(date~ent)
...cAC Referral Sent:
Aate of Inspection: ,;
_Receipt ofCAC Report:
_Lead Agency Determination:
Technical Review:
~ublic Hearing Held:_t:t '~~Ið ~
Resolution: \~
N~,"f APPI"''''~Mr,~ II.- \("":rl?tç<" ~
Address ?->lo Ärw'O. C-j'J \tJo~;f3l21"1f'X, N'~ 1\lC12 C\\;\b~ð! BY
Ph~ N"mb~( ) (f,"0-cnq-S'öéf'2 ~~~
8"""lk Coo~y T~"" Nm"",,, 1000- QiO<o - ? - 2 ,<j 2 ¡I- ~~
propertyLocation:6.~IJe.... 0-+ Mill\\ 1200.d) h~Ììt- of4 td-w~¿r\ v~ /
1-;\(\,> 1t-1e $ -'-102 Cl.v1d 4o~ A .k.A. 579~ 13 /'J\CL~r\ ï?ð., ~L.cthöld vi,l
(provide LILCO Pole #, distance to cross streets, and localion) -\( J
AGENT--N0nr/ - \-l~ ~
(If applicable) .:f ~ ~
Address:
Minor
AUG 2 0 2002
Ii; .
'.
b:!~
- --
, .
,..
Phone:
.
.
Board of Trustees Application
GENERAL DATA
Land Area (in square feet): 78) 1 tog sf.
Area Zoning: Lol"ìed Ä - i¿e:::,./ /~'r:
Previous use of property: V O_Ct:L1"ì t \ 0+
Intended use of property: ~ \ Iì:j Ie- -f~1 kl~ We. \ l ì I'ìCJ
Prior permits/approvals for site improvements:
Agency
-Bl1lì\"\IJ Prrurd
_L-b¡J.~ ~¡rt.
D.E.C
Date
::3lAl\t-ß I ¡q<öG
"£~D-OI- OOQ3 ~l ~ 0\
J&x- ót- N~¡\ì- ~ )u.(Y::Lt.idìDI'ì .::::L..ne-lS) 01
. _ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
~No_ Yes
If yes, provide explanation:
Project Description (use attachments if necessary): . ~ >rL1
bi(\~e.---fwV\)¡~ dwdl;~ ¡Nim 2c.w- Q+bc..hed r¡:f-~TWf .
'S\yULtU)( L Lù i \\ 110.... 'Ie..- ().. W'{o-..p O-IrDLlv0. 0rc~-to
n.. ckcL.A\áo ~c.hf~ ~írN~IOV\ ~\'..po~¡b\e. lYì-S'(ou.rJ
pcd. ~.Rk.u~r~ p'!r~l~"'~()'{\ --+-D de.o..x- '+' wide... ~(.)+ pæl-'h
ð.~W¡\ -reo, W~'í -To tR-C.O\{eK<Et\ wM+\ WGod e..hipS.
.
.
Board of Trustees Application
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: ~:n ~~--ça.x)'\\ I~ pel(\'\'\ú-.tîV\..+ hom€..- .
Area of wetlands on lot: ¡ 2 () 6Ö To<. - square feet
I
Percent coverage of lot: 15 %
Closest distance between nearest existing structure and upland
edge of wetlands: 0 feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ICD feet
Does the project involve excavation or filling?
No / Yes
If yes, how much material will be excavated? tJ..\ì'tn()UlUbic yards
WI. U\O (}vf'.
How much malerial will be filled? iÚ- -+fu~ -time... cubic yards
Depth of which material will be removed or deposited:úffn>\C, '3 feet
Proposed slope throughout the area of operations: 2:f"ck -JD ,.e.¡.·v\G:LI\ ct.:::' '\ ~ .
Manner in which material will be removed or deposited: ~ x1'n \r,~v-
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):
N2>Iìe.
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
-----------------------------------
SEP 2 0 2OOê-
In the Matter of the Application
Of~
~__11_~______ Q~~----
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING
I,. NCl.Iì~ F\., \(Df\~\e-\-c.'), residing at 5 \Q Är\.V\(}... Ct - )
~~~~~~~; ~~;e a~~l~~
That on the i I ~ day Of~. , .2002. I ;>ersona,lly posted the
property known as 51'157) Mo..\\"'\ ?NY:I ~
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 O~he ~
~u~~ic hearing. Date of hearing noted thereon to be held ~
'r:J:P 11- tv.. Iv ~ ') t r-4V--(f Ih . .
Dated:
'YlnJl'tj (} t:~Jo.f¡¡j
'(signatu
~~~to be~~e fe this
.~'- ~ay of~ 200~
~ir ~~
Tanya Lachenmeyer
NOTARY PUBLIC, Stato of Now York
No. 01LA5032219, Suffolk County
Commission Expires, August 22, 202>lo
.'
H-1ç.4 (2187)- Text 12
I PROJECT I.D. NUMBER
.
.
617.21
Appendix C
State Environmental QuaJity Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be camp Ie red by Applicant or Project sponsor)
1. APPLlÑ~P.ONSO I 2.
3. PROJECT LOCATI N:
SEa
Municipality County
4. PAEC:SE LOCATION (Street address ana road intersections, prom ¡~nt lanOrnarks. e!c., or provlae map)
5. IS PRO QSeD ACTION:
o Expansion
51 C{ 5 'a Mailì 1:Þad.
-:) OLtthclcl, N ,'/. ¡ \ C[, ¡
o Mooificalionialteration
~~:B~P~OJ2T~:~~\;'rD.~--Ç;µ"-'lLt cl.well\~ w,--IT\. ~ 2- CfM.cr::.rO-Cf-CJ.J\cl~1
þ(J.~e~. Dwe..t\'LX\"'a.~ Œra.p CL'ro<3:'1'CI Çtrrh -tD ~d.=.k..., D,("'~I -h:,
De. p()..\¡«l.Þ>J.'Z><>,-Th LUIcI'r\S'rt>"-1'd P=\-~-,b\ï) ct\'\.d -it> cl.e(ì.j¡- 4' ~
-tð wCl>\elr' (:R)'lv( e.ð. w·,+h, 'Nooct cl\ì ~.
7. AMOUNT OF UNO AFï=¡::CTED:
Initially \ . ß l acres Ultimately éXl..h\~ acres
a. W~yRO?IJSEO AC710N COMPLY WITH ËXISTING ZONING OR OTHEM EXISTING ¡....AND USE ,QeS7r:1ICïIQNS?
~ Yes 0 No If No. describe brlerly
WHAT. S ?RESENT LAND LJ:3ï::. IN VICINITY OF ?AOJECT?
O,~ncus:rza 0 Cùmmercia!
~grlcunure
~ ParK/Forest/Ocen scace
L,jOlher
10_ DOES ACTION INVOLVe A ?r:AMIT APPROVAL OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVEr:!NMENTAL AGENCY (FEDERAL,
STAT~ GjYLOCAlJ?
~Yes 0 No If yes. Jist agency(s) and permit/approvals .
Su..Bo\L Cco.-I'--tv), ~ ¡JI.D{. -WeR-l--\t\ ~ \~
¿' .. ;J:)" 0W It:ltv "'
". __~9ES ANY ASPECT OF THE ACT¡or~ HAVE A CURREN VALID PERMIT OR APPROVAL?
ISlVes· 0 No II yes. list aeency name and permlUapproval
Dsc. ·\eÆby' cf 'l\c>\\j-t-' l~cI-i()ýÌ
.:r-
12. AS A AESULT OF ~OPOSED ACTION WILL S<ISTlNG ?Er:!MITfAPPAovAL REOUIRE .'-10QlFIC':"7ICN?
DYes ~ó ._.
IFY THAT THE rNFORMAT ON PROVIDED ABOVE IS TRUE 70 THE 3EST OF MY KNOWL=-DGE
~ NCi.rI~ A.. JJ.'ÍÀA 1.'1+ ¡q(q
. \ Dò'. ~2.
Apclica
If the aClion· is in the CO<lstal Area, and fOU are a stale agency, complete the
Coastal Assessmen~ Form before proceeding with this a~~essmenl
Signature:
OVSR
?Aï=\ï 11_=NVIF\O~JMENï,;l'
.... CCES .J.C7;C,,,, =.":C;::~: ':'.\lY .
':'~s ,- :-.10
3. 'NIL~ ..:...C7:CN .=1E·::=:;VS; :::CPOlNA7~J .=lEVtE'N....S .:::P.C'JIOEJ =.:¡::; UI'IL.S-;-=.:I .:..C7iCNS;N:) .\ '(C:::R. :::.o.\ñï '5;;".:57
:nay oe sucersed~C :.y :=.nc(:,,:er ;nvalvea açenc'l.
L...: "'es ,-:-'¡o
. .-~1-' -' -., "po ................·¡:::¡t"',.... ""1 -\.-"",..,C·
.::III C, L 'oJ ...J~ '.....'.,....I_.<;..~... ~~..
,.-=S. 7¡"';?E3r-:GLJ IN'; ~~"'::=¡::;. .:o.:...;:.ï ';'ì -:? it yes.
:ocrOlnara :ne re\ II~W ;rocess ana 'J:!>a :I"'.a =;JL_ ::~r
.
:t .·~o. 1 :'1eO:;:iC:'a -:::2C:,U:=:
c. ':::ULD ,..:..G7;CN ::I.ESUL7'·N ANY ADVE=='SE =::~~·:ï5 ..\SSCC:..;ï2:J 'Nlï:-! -:-5. .=·JL:,,':WING. :Ans'Ners .;'Iay:e unawm:e!1." .e";J~I~!
ç,. =:ClS,lnç .llr ~uaIH'f, 3urtac2 Jr .¡racnowa(er ;:ualily Jr :l.:antlty, .'OIS& .e·/'!IS. ~X:S:InÇ :~a¡f¡c ;at:~rns. sOliC .vas:e Jrcca.:c::::n .:Ir JIS'::;:
potentlaJ fer =rOSJon. ::ralna<;e or :Iooolnq jroClems? :"-::olaln :)rlelly:
cz. Aes'he!tc. açrlc:..zUural. 1tC:1aeoJogICJJ. :'IS,O(lC. Jr Jlher ,a¡:..zral .:Jr cultural ~esourc~s; :Jr .::ommunlty or .1elç:1CCrnooa .::::;rac:ar'? ~Dlaln ~.
....... 'Ieçetatlon or :auna. :15n. melUlsn or 'NltaUle s~eCles. SJgnl¡¡canr :'IaCllal.~. :Jr :nre-.atened or ~nc:ançerea .scec:es? Sclam Jrt<!lly:
C-='. A ç.::mmumt'f·s existing ;¡!ans or :;¡oals as OtflC:êilJy aaootea. ar a cnange In use or intensity Of usa of land or other natural resources? ExplaIn ::;
CS. Growln. suoseauem :e\ eloament. :Jr relalea ac::vllles likelY [0 Je Inducea Jy !ne ~rcoosea aC:lon? Solaln :)neilv.
G5. !..cng :erm. snort :erm. ::,¡muiallve. ;:Ir ::I,her ':Hfeç:s not l1::efltltiea In c~·":.s? :=:(:::Jlam Jne!!·I.
':t::-=-r mcac:s inC:.JcInÇj :::ançes In :.Jse of ~:iner qcanuly ?r :yce or ~nerçYJ? =-(;)I';'ln :ner!y.
'J. 5 ::-fE::iE.:::A:5 -:-;..,=::ìE -":K.::!..::":-C 5E. :;:::Nï;':¡CVEF;S'( ~E!..A,E:J 7"0 .;:IOT~:- j!;'L ..:.8vS::!SE :'?'IV¡RONME~lï;'L :~.:P~C7S?
_'fes
_,'/0
" ·~es. ~XClaln Jnellv
?AR, III_OEí,,;:¡MINAïION OF S¡G~IFICANC= ,To ~e c:;¡molered ~y Agency)
INSïRUCi"10NS; For ~3.C:1 aaverse eHec! identified accve. determine wnettler it is sucstantial. large. :mcortant or otnerNise signlfic
:3cn :!tfec~ Si10Ula ae assessed in C.:Jnnection witl1 Its (a) setting lL2. urban or rural); (bl ¡Jrooacility ot oC:=:J.:!:õ1.r1g; (c1 dur2.tion·
irreversibility: (e geogracnlc 3coce: ana (f) magnltuc:e. It necessary, aad attachmentS or reference supponing maIerials. :':1sure
eXPlanations ccnt310 suttic:ent deJ:all to snow tnat all ~e!e'/ant adverse impacts nave been identifiea and adequatelY acCressec.
CleCK .his box ;f 'f0U have ¡dentifiea one or more :Jotenciall'l lan~e or significant ¿c'/erse imoac:s whlC;1 ,'.,..:..'~
oc:ur. ïhen ~rcceea airec~I'I to ~he FULL :::AF :;a.na/or prepare a positive- declaraticn.
_ C~ecx ~tlis ~ox it you have de~ermined, :Jased on the information and analysis above and any SUDoort:¡:Ç
doc~r.:enratlcn. :hat :l1e ;:¡rooosea :1c:ion ':JILL ~lOT result inJny sIgnificant 3cverse anvircnment;;:.! ¡m:Jac::
AND .:Jrovlce :In 5..t3C:1ments .3.S nec2ssar'l, ehe ~easons supconing mis determlnarion:
"""'>! " _c..<J "''õ~nC'1
""nl J' ~~<: .....,1'\1" )1 <L',;¿Or'l\IOL<: ....1I.c~r n ~c..O ",;\;r'\C·{
:.u<: ·JI .o{L·~OOI1.\'O'<: ,j",c~r
,,,,,n.JIW!!' )/ <o!'<con<IOle ':r~'(~r.n .C:JCI .\';C:r'\CY
)'I:r'\..:ur~ )I r""'-'oIro:~' 'Ir ..:rr:e·"'"1 :rcm ,,,"~aon"o.~ ..HI,c~rl
J..¡C
:2
.
Board of
.
Trustees Application
County of Suffolk
State of New York
~~ h. t'(Ì{ì~ctos- BEING DULY SWORN
DEPOSES AFFIRMS· THE/SHE IS TlŒ APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF illS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN TillS 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
REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF TIllS APPLICATION.
)1a'Y1~,o t::v#S .
S ature
SWORN TO BEFORE ME TillS-1 ~ DAY OF _Av-"ð'.A.s+
20 ð'ð
,-
~\-- ----~
Notary ic
Tanya Lachenmeyer
ZOTARY PUBLIC, State of New York
Co. 01LA5032219, Suffolk County
ommlssion Ex .
pires, August 22, 20~
.
· Auf* ¡q) 'þ,32-
FORM I
,
1\.1'PLtt!I\.NT
TR~NS~CTION~L DISCLOSURE
The Town of Sou~hold's Code of ~thic6 Þfohibibs conflicts of
in~eresb on bhe part of bown officers and employees, The
purpose of bhis form is bo provide informabion which can
aler~ bhe bown of possible conflicbs of inberesb and allow
i~ ~o bake whatever acbion is necessary bo avoid same.
YOUR N/\.HBt
" .: ;,/.,:. ~i;~ ..:o: ~
I .,.. ...;11·~~,.· {¡.~.I¡,,¡,.'Þ.t"¡;1...
. '. ~';I. .' ", '.' .,It·~.
NI\.TURE O~ ^l'PLICI\.TIONI (Check all thab applY.)
.'; ".,~~(..:.::~.. 'i;..: :1¡Jf,'-:·!~'
Tax grievance
Variance
change of zone
^p'p~~al of plat ,
Exe~ption from plat or official map .
other \.1 \ d h-- I r.~,.J.c~ J..".
(If "other," name the acbivHy,) v~O:\-o.rì /IW",+.f>Q ~IC?CIIOY\
Do you personally (or through your cOMpany, øpouøe, sibling,
parent, or child) have a relationship with any officer or
employee of the 'l'own of Southold1 MRelationshipM includeB
by blood, marriage, or business interest. MDusiness
interest" Means a business, including a partnership. in
which ~he tovn officer or employee has even a partial
ownership of (or employment by) a corp.oration in vhich
the town of ricer or employee owns more than 5% of the
shareB.
....
YES
NO
/
If you answered ·YES,N. complete bile baiance of tbl~ torm and
date and sign vhere indicated.
.:.'~.' '.
Name of person employed by the Town of Soubhold
Ti~le or position of that person
Describe the relationship between yourself (the applicant)
and the town officer ør employee. Either check the
appropriate line ~) through D) and/or. deB~ribe in the space
provided.
The town officer or employee or his or her spouse, eibling,
parent, or child is (check all thab apply).
^) the owner of greater than 5% of the shares of the
corporate stock of the applicånt (when the applicant
is a corporation),
B) the legal or beneficial owner of any in barest in a
noncorporate'entity (when the applicant is not a
corporation),
c) an officer, director, partner, or employee at the
applicant, or
D) the aptual applicant.
. ~.'
..';':,
. . ~'~': ....
,.
DESCRIPTION 01." nEL^TI0NSIl1P
. '. .. . .,., . .'"j .~ .~ "
'.' .
¡,..
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:~~ii!,
c-z . .ti'~..
199_ .
~: ,.:':..
..... ':':;";'::¡~(t;·'
¡¡£j'.ÚÎ'f'~_·' '\:,.
,,~,::',.~f)\. .~~\~. ., .~~: ~.~:~.:.
.,...,.....:.:-,~."'~.i: ~I.\~.
.·,.·t¡;,\ J
.,....;¡,;~~l,.J