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Home My WebLink AboutTR-6000Albert 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0082C DateNovember 15, 2005 THIS CERTIFIES that the beach stairs At /4630 Blue ltor±zon Bluffs, Peeonic Suffolk County Tax Map # 74-1-35.51 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 8/16/04pursuant to which Trustees Permit # 6000 Dated 9/22/04 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 beach stairs The certificate is issued to CHARLOTTE DICKERSON owner of the aforesaid property. Authorized Signature Albert J. Krupski, President James King, Vies-President Artie Foster Ken Poliwoda Pe~y A. Dickerson Town Hall 58095 Route 25 P.O. Box 1179 Southold, New York 119'/1-0959 Telephone (631) 766~1892 Fax (631) 765-1366 BOARD OF TOWN TRUST~,~S TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction ~ constructed Project complete, compliance inspection. Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK CHARLOTTE DZCKERSON ISSUED TO ........................................... · .......................................................................................... Pursuant to the provisio,,s of Chapter 615 of Se laws of the State of New YorE, 1893; and Chapter 404 of the ,L~. ws of the · State of New York 1952: and the Soufhold Town Ordinance eh- tffled ."REGULATING AND-THE PLACING OF OBSTRUC~Ti~JbIS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL. OR OTHER MATERIALS.FJLOid LANDS ·UNDER TOWN WATERS;~'. and in accordance wlfh the Resolution of The Board adopted at a meeting held o~ ..~.§.P.~:....~'~ ....... 20~.(......., and in consideration of the sum of $25~..~.0 ............ paid by Ch~otte Dickerson of ................. _l~R-.k ....................................... N. Y. and subject, ~o the Terms and Oondifions listed on fha reverse ride, hereof, of Southold Town' Trudeos authorizes and permlfs fha f¢iJowing: Wet~and Permit to co.truer b~aeh stairs from the top of bluf~ to the beach with the condition of replan&ing the ~a of dist~bance from construction with American Beachgrass and as '~epicte on th ns 'v' · 0 · the originating eppl'~.atlon. IN WITNESS WHEREOF, The sald Board Of Trustees here- ~ causes its Oorporafe Seal to be affixed, and those present~ to subsc~oed by ~a majority of the said BOa~ as of this daf~. . . .,....~, '''. .' 1"r'\"','''IT1,",~!~ 11ìe Permittee C Iu:vz.lo:t:te. V;'ek.vu> 0 11 residIøg at Ma.:t.ü:tu.ek. .. , N. Y.. IS part. of the coasIdetadoo lor the ¡...,.~ of che Petmit cIocs bØdeøIIIod &net prescribe to the foI· towia&: 1. That chc said Øoud of Trustees &ad che Town ol SouIhoId arc rdeøed -1-. any &ad aU damages, or claims foe damages, of au1ts ari$iag. ditecdy « b>cIirec:dy as a ~ of any opec- .adoapctfomacd ("IØII,ntcte.ëls I""""'t..d.tb.c .taI!l&ml!_.m.~~. ør.~ own ~. defend -lAY &ad aU JUCh 1UIIs'lnltI·tedby 1bIrcI.,udcs, &ad the said 1\ m.I/IN '" . 'f fan IIohWty wich reSpect chereto, fa 'Ibe r'1lpt-tcesdusioo of chc Bøard of T_ of the Town of ~. . 24 . Z. That chis I'eðDk Is ~ for a pedod of· . !DOS. wbId. Is (W s1~'''Ðd to be the ~tcd time· requited to mCnpIcte the wodc Inwl\'eCl, f>atihoald circ:umswxes waaaøt, rec¡aest . for an exœasIoo ·may be made to the Baud at a ..., iI.ae. . ,. That this Pcrøñt ahould be ~ ladefiollely. or as loag as the said PermIttee wisbCs to ....1....;" the sauaurc or prQjca InYolvcd, to provIdc cvidcace to anyo.... mnœraed chat 1IIIh- om.doo ...... odpaUy obtaIoed. ~. That che wodc involved "4ri1I be subject to chc ~ &ad approval. of che Board or Its agents, and ooa-oompll....... wich chc prcmsioøs of chc nrlg/n.t:lng applicadoa. -r be ause fot revocalÍon of chis Pamit by rcso~ of the said Boud. S. That chclIO "4ri1I be no uø.realOldble inta'f_ wich na~ as a aedt of chc ,.œ beteIn aùtborizcd. . . . 6. That chclIO IhaU be 00 iaterferenœ with the rip of che pubUc to pus md tepISS IIoøf che bearh Letvi_ 111gb md low water ~ 7. That If future opendoas of the Towa. of ~ nqaIte die. -r md/ot lI_doo-t In the Ioro""" olthe 1IOdc IaereIø. .od>o.lwd, or If, In che opI"'oa of6e Board of 1'.-, &be. wod;. aba11 ause anretCOOlble obstracDon to free navlploa. chc said Pe<-I~ "4ri1I be ~ apooduc oodœ, to remove or liter chis ,.oä: or proJect bereIn ItaIed wkbo.It «'T ¡DOC' to &be Towø . of SoIdboId. . . 8. That chc aid Board "4ri1I be oodfIed by the I'øn.l_ ot &be ~.' of !be ,.oä: loth- odzed. 9. That !be ·p;.rmI~ "4ri1I obtain aU ocher (>etJDia &ad ......-.. 6at .., be nqaIred .. 1"-..1 to this permit ~ -r'be IIIbJect to moire apaa fIIIaro to oIxIIa aD. - - . . 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 22, 2004 Mr. Allan Dickerson 460 Paddock Way Mattituck, NY 11952 RE: CHARLOTTE DICKERSON 4630 BLUE HORIZON BLUFFS, PECONIC SCTM# 74-1-35.51 Dear Mr, Dickerson: The Board of Town Trustees took the following action during its regular meeting held on Wednesday September 22, 2004, regarding the above matter: ViHEREAS, Allan Dickerson as agent for CHARLOTTE DICKERSON 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 August 16,2004, and, WHEREAS, said application was referred to the South old 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 22, 2004, 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, 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, RESOLVED, that the Board of Trustees approve the application of Allan Dickerson as agent for CHARLOTTE DICKERSON to construct beach stairs from the top of the bluff to the beach with the condition of replanting the area of disturbance from construction with American Beach grass (Ammophila breviligulata) after the stairs are completed, and all as depicted on the plans received August 16, 2004, 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: $50.00 Very truly yours, ~?~.~.. Albert J. Krupski, Jr, President, Board of Trustees AJKlhct . . Albert J. Kxu~ki, 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) 765·1692 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: l\-!I tv, D ,C~ Please be advised that your application dated ;h-t 6 ' , , ;). 00 'f has been reviewed by this Board at the regular meeting of ~+ 2.1, 1. "ocr and the following action was taken: ( ~ 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 following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: hl'l tL ( ill jf(c+'·.).'\ f.e.e USo TOTAL FEES DUE: $ 50' 00 SIGNED: dI~....J' 9· ;¿'''l.d't}. PRESIDENT, BOARD OF TRUSTEES · , 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, September 14, 2004, the following recommendation was made: Moved by Doris McGreevy, seconded by William Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of CHARLOTTE DICKERSON to construct beach stairs from the top of the bluff to the beach, Located: 4630 Blue Horizon Bluffs, Peconic. SCTM#74-1-35,51 The CAC recommends Approval of the application with the Condition the bluff is re- vegetated after construction. Vote of Council: Ayes: All Motion Carried -------~---- -----------------~-------------~-----~---------------------_._-----~- ..(~., ~I , , î.. r~ ~.' t ~~h I 'w..... ..(, ( "" ' I . "'~, ........ ,.,,~ If "'l'"..... 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"'\........~ f") # lj1 K:' ,- r',¡'" ':::! \ j,J ~< ..:....- I~ '0 Î '..;..¡ ;J ". ~êU'~µ1~~ ï1~~mcOJtJ ~.. ñ\õ=m\J< ~~.., :t:<r1Ì ('I ~ ~ :E () IJI -< ~:I:0 ~ AJ () () ZOO N__ ì1 ::tï~ ()¿'r - \J('\ Z3:a ~ lJ1}>-I -0 -- () 11 .:.4,*1 r- ~ *.#þ úI"~ ~ \,^.fC- <-, . ~ ~., . - .-." ... , ..... ""'C, H~: H ·r ':r IE rrYj I r,,_' '~ i: 'L'.' ~ IJ oj _~ n'.) I.l . .,', l~__~_ 'I .. "1'::', . U I i nUl,.. 1,' c,"1,,~ "~ .' u"! > ÀÜ"0.;J '- ~, '. . . "f of . ·~1.. ~ -..;.. . H. íòy öf ~ .. Southold Town Board of Trustees .. -,-. . . \alf.,\'( VttA k .. -- .".--"---- . Fó\~ '^ r .1:- Û.{~ ,1. · .- - --- ~ - - --. ...-. -.....- - --. -- - .._-, ... .~. " -- .d' ~;f~J n' 1)-1 .' - .. . -.- - .-.. " ~1~~~~4"1 1· .~.---._- .,_. ,-~ I ...~. ,----.- ·-·t '" . '-- .' .~.- _ ._. ..'_ ________ _. __d.._· __.-. .. .. ---_._,---- -. ..-.-.--- - . A~" -?, -------,.. ..- .-- ------.. . ---"--. -- -. ~I _.\..ÞJ.\,^~-'" ! .. ~__~__ n. "'T.:L _, ,. _. _" ___.~_._ . S1í "'. n" _.. ,,__. ,., :E:(~ ,I '..'- ," ~!q'l , <. ....-,-~' ... f otJ \A.f.. \ )\ Ithl:'J.t..( . ¡¡;(i;¡¡;R~~~ o AUG 1 6 2G04\lidJ . ..... - .-- - .$l)Uthold .lown _ .. .. _ '. ' Board o11rusteeS ..-._-_..--- ~~t' Vejh~AtÀtO.r...._" .,_--on.. y~"--'-d"-'---d' .. d..._ m_ ___...... ......_.. d, ,,' ~.".,' ~llJr5}4t(j ,. ,._ . . __..__un . ___ _._ - - _._n. - . --. -- TÐ? f) t:. 0,"-"k' '. r '., Ié) t.V\ 1\ ~~.Q. , ~ I I t I I -z.. Lt~A~J orfr .-\w'; . 6 Ve{~\tl\t &(~f ,. ---- /B:~"l ') '~'d".,,_. ,/ ~~., ~ - - _. "'c...,...-"" .~\.~ ~ ~ -- --- " Southold Town HaIl 53095 Maio Road P.O. Box 1179 Southold, New York 11971-0959 ZBA Fax (631) 765-9064 Telephone (631) 765·1809 hrtP:/lSOUtholdto~Ébne:~ "l;,;"ftlY . ,MAY 7ðO~ ~W.CI.rk APPEALS BOARD MEMBERS Lydia A. Tortora, Chairwoman Gerard P. Goehringer George Horning Ruth D. Oliva Vincent Orlando BOARD OF APPEALS TOWN OF SOUTHOLD FINDINGS, DELIBERATIONS AND DETERMINATION MEETING OF APRIL 17, 2003 Appl. No, 5256 - Charlotte Dickerson, Property Location: 4630 Blue Horizon Bluffs, Peconic; Parcel 1000-74-1-35.51. SEQRA DETERMINATION: The Zoning Board of Appeals has visited the property under consideration in this application and determines that this review falls under the Type II category of the State's List of Actions, without an adverse effect on the environment if the project Is implemented as planned. PROPERTY FACTS/DESCRIPTiON: The applicant's 73,629 sq. ft. parcel with 46.64 ft. along a private right-of-way, extending 4332.44 feet from Middl. Road (C.R. 46) In Peconic. The property is improved with a cottage situated at +-6 ft. from the top of tile bluff and 42 fe.t from the south.rly property line at its closest points, and accessory shed at +-30 feet from the top of the bluff and +-15 feet from tile east side property line. BASIS OF APPliCATION: Building Department's September 3, 2002 Notice of Disapproval. citing Section 100-239.4 and 100-33C, in its denial of a building permit for: (a) tile proposed new location of a dwelling, replacing the existing building, with a setback at iess than 100 feet from the top of the bluff of tile Long Island Sound, and (b) a proposed accessory building in a side yard area FINDINGS OF FACT The Zoning Board of Appeals held a public hearing on this application on January 16, 2003. February 6, 2003 and April 3, 2003, at which tim. written and orai evidence was presented. Based upon all testimony, documentation, personal inspection of the property, and other evidence, the Zoning Board finds the following facts to be true and relevant: AREA VARIANCE RELIEF REQUESTED: Applicant wishes to r.locate tile existing cottage landward of its existing location and less than 100 feet from the top of tile bluff of the Long Island Sound. Applicant's 10-16-02 survey prepared by John C. Ehiers, L.S. updated 11-21-02, originally planned a setback at 24 feet from the top of tile bluff, Subsequently, applicant submitted a 4-9~03 revised survey proposing a new location of the cottage at 36 feet from tile top of the bluff at its closest point, 20 feet from the closest (south) property line, and approximately 45 feet from the east property line. The accessory building Is also shown on the survey at +-30 ft. from the top of the bluff, as exists. Page 2 -April 17, 2003 Appl. No. 5256 - Charlotte Dickerson 74-1-35.51 at Peconic REASONS FOR BOARD ACTION: On tha basis of testimony presented, materials submitted and pe""onal inspections, the Board makes the following findings: 1. Grant of altemBtive rellBf will not produce Bn undesirable change in the character of the neighborhood or a detriment 10 nearby properties. Applicant's cottage is being relocated landward from the top of the bluff on this somewhat small, uniquely shaped parcel fronting along the Long Island Sound. During the hearings, tes~mony was tBken from both the applicant's husband Bnd nelghbo"" regarding the proposed placement of the existing cottage. The Board request thBt the loca~on be moved farther back from the top of the bluff to a location that Is more conforming (36 feet instead of 24 feet), and this loca~on would allow the applicant to create B greater buffer between the cottage and the top of the bluff at less risk. 2. The benefit sought by the applicant cannot be achieved by some method, feasible for the applicant to pursue, other than an area variance. For the record at the first hearing the applicant Indicated that over $50,000 was spent replanting the bluff and bulkheading along the toe of the bluff. The parcel is small and variably shaped. The only alternative for thB applicant to pu""ue are the two applications before the Board for the cottage relocation and shed location. 3. The amount of relief is substantial based upon present code requirements, in that the present codB requires a 100 ft. setback from the top of the bluff, The Board's request to relocate the cottagB at 36 feet Instead of 24 feet presents a 64% reduction of the code requirement. 4. The difficulty is sBlf-created based upon the present loca~on of the cottage at 6 ft. from the top of the bluff, the requested 36 feet from the top of the bluff, and the code requirement of 100 feet. 5. No evidence has been submitted to suggest that the proposed increased setback of the cottage, or maintaining the location of the existing accessory shed. will have an adverse impact on physical or environmental conditions in the neighborhood. 6. Grant of the requested variance is the minimum action necessary and adequate to enable the applicant to enjoy the benefit of a new location of the cottageJdwelling, while preserving and protecting the character of the neighborhood and the health, safety and welfare of the community. RESOLUTION OF THE BOARD: In considering all of the above facto"" and applying the balancing test under New York Town Law 267·8, motion was offered by Member Goehringer, seconded by Member Orlando, and duly carried, to Pogo 3 -April 17, 2003 Appl. No. 5256 - Charlotte Dickerson 74~1-35.51 at Peconlc DENY the relief requested to relocate the cottage at 24 fj, setback from the top of the bluff, and to GRANT Alternative Relief to relocate the cottage at 36 feet from the top of the bluff, and maintain the existing location of the accessory shed, as shown on the 4-9-03 m.p prepared by John C. Ehlers, L.S. This action does not authorize or condone any current or future use, setback or other featur. of the subject property that may violate the Zoning Code, other than such uses, setbacks and other features as are expressly addressed in this actian. Vote of the Board: Ayes: Members Tortora (Chairwoman), Goehringer, Homing, and Orlando. (Absent was Member Oliva.) This Resolution was duly ado te 0 . Lydia ortora, Challwoman - Approved for Filing 5/ b /03 :¡,. , . , , y /- r' . , '::'< , L. Y ~\ - k: ~ ;, , ~ ~ ~. r- " v -¡ r- () -0 r0 ~ ~ {j -'"- 0':f. '-" -~ ?;... ~'I-.i ~ '" ~..J~ ~ :;:~ '" , " ¿ \>' ~~_...~-----....-~- -' . .-- -- -~ ....c==--_..;.-"":"" I I I I I I I I I I I .F I I 1 I I I I ! - .- _Coastal Erosion Permit Application -Wetland permit Application ~jor Waw~/ADxn ~es ~eœived Applica 'on: ....Received Fee:S ~mpleted Application _Incomplete SEQRA Classification: Type I_Type Il_Unlisted_ _COOrdinatiOn:{date~ _ CAC Referral Sent: ~te of1Dspection: , _Receipt ofCAC Report: _Lead Ageœy Determination:_ Technical Review: ooP!(1)!ic Hearing He~ Resolution: ,.\. . I tl ,,! \~.r~ -.""'- _ ,fI", ,c.. ..-l ~tt.'<>«((,\""" Yî\ (\ á\íC Ie.. w ^ "'\ '1\ '\A"8 .l'^-l..t. J1d nCt S 1 Phone Number:(¿ j~ L 'I) - '~(t (( I ,f . Suffolk County Tax Map Number: 1000 - --11.=J ~. i{ i Property Location: ~1P i3llA.t. i\¡¡(\'Z..<\'I. t3Q,( c\\\~ t::I I " \ ¡: ~. , - A \JÎ-\. .. i2 {I (provi e LILCO Pole #, distance to cross streets, and location) Æ\L\Ii\ Q. '1;}I(.t~f...fl\. ~ Albert J, Krupski. President James King, Vice-President Artie Foster Ken Poliwoda Peggy A, Dickerson Name of Applicant , , g¡..r ;v Address AGENT: (If applicable) ~l(. O~~1. Address: r<'l' . Town Hall 53095 Route 25 P,O, Rox 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOtrrHOLD Office Use Only Minor fõ)[E(G[E~W[E lfìl AUG 1 6 2004 Southold Town Board of Trustees k I(Lt !~I(\ I I (t() I..- ~ &; cJ..,\ \1 \&1 p¡ tUII(\' WJ'1 ' }\\ L' h"~ hAJ<.. . , 6>1- 1-"J' l{lu.L Phone: . . Board of Trustees Application GENERAL DATA Land Area (in square feet):-16 , l.:.v"¡ J 1 .ft-. (I . ('I A.. Ì-- Area Zoning: R R Previous use of property: \-"{\~f<tt ')~ ~çM^l (Il!:,A"ol\I¿ I Intended use of property: II '1 II Prior permits/approvals for site improvements: -1t f\g~y 'f!' . \.,1. \ ,';' L tt-/"'i1'!kLOi' ...'('(\' 'J (. C,ì\lt-.h '\(\\\\ 111l~hl~(!1t+ ,',' tf ¡{ l'V <f, ./ . tf" 'I~ , ' d\.ì\\~'.J..l !tW1\. =t3~ 4- H}li, ~ 1 \.1~ V~ill"'(. I)';'/(' 1"' :\ L. . / . ,)Qthw\.l'VV,h\ I ~~~I It· ~'3 -It ~,,~A~'1\ [¡~ ':'$\~~"'l') iA,(th.., \l~~'. ~ ~éSlt~,^"e _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or SUSpt1nded by a governmental agency? ~ No 'res ~- If yes, provide explanation: Project Description (use attachments if necessary): IÎ :1' f ~ It)\\S~ÝIH i"" f' ç AI"~ h \\Aff .}n )Wý\ c k . -6t\V\ ~ J . . Board of Trustees Application WETLANDfI'RUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: .J:., (c.e ~ S ,~ù bú\, ~ I Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge ofwet1ands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? ''/.. No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: A'; < '\¡; ~ '> ~;""I Manner in which material will be removed or deposited: Statement of the effect, ifany, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ~\ \/\'\ t- . . Board of Trustees Application COASTAL EROSION APPLICA TION DATA . Purposes of proposed activity: S'b\\V'. \--.> \Jh\L\.. Are wetlands present within 100 feet of the proposed activity? No rf.... Yes Does the project involve excavation or filling? .~ No Yes - (cubic yards) (cubic yards) If Yes, how much material will be excavated? How much material will be filled? - Manner in which material will be removed or deposited: - Describe the nature and extent of the environmental impacts reasonably anticipated resulting fTom implementation of the project as proposed. (Use attachments if necessary) ~\\¡~¿ . . I PROJECT ID NUMBER 617.20 APPENDIX C STATE ENVIRONMENTAl QUALITY REVIEW SHORTEN~RONMENTALASSESSMENTFORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME SEQR PART 1 .. PROJECT INFORMATION 3.PROJECT LOCA nON: Municipality p~ l ~ '\i\U" 4. PRECISE LOCATION: Street Add... and Road County r r . Ji,\tll>ll Intersections. Promtnent landmarks ete - or provide map L, 11" \ s¡,,\.\"(hVI~'\~ , ". L" í6l \.I.l t~.:,\' i t..NI.'j ((. l, Io 1'11 if ) 5. IS PROPOSED ACTION: blI New D Expansion D Mod1ficaIlon J alteration 6. DESCRIBE PROJECT BRIEFL V: C(\\Jh~c;\-- ~ ~,-r. ~+ ,\ w.> ,~~ A,:.. ,. y bCth'" ' to; h \ *,{f- ç.:;\o\ \'\ J 7. AMOUNT OF lAND AFFECTED: IniliaUy acres Ultimately ...... 8. WILL PROPOSED ACTION COMPl V Willi EXISTING ZONING OR OTHER RESTRICTIONS? 00 Ves D No Ii no, describe briefly: 9. WHAT IS PRESENT lAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) 5ZI ROIidentiaI D IndusUial DCommercial DAgricut\tAre D Par1t J Forest I Open Space DOIher (describe) 10. DOES ACTION INVOlVE A PERMIT APPROVAl, OR FUNDING, Na-N OR ULTIMA TEL V FROM ANV OTHER GOVERNMENTAL AGENCV (F_ral. Slate or Local) Dves OONo Ii yes, list agency name and permit J approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLV VAlID PERMIT OR APPROVAl? DVes DNa Ii yes, list agency name and permit J approval: UL T OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? No I CERTIFY THAT IS TRUE TO THE BEST OF MY KNOWLEDGE Dale: vl-z.\ 0" AppJicant I Sponsor Name Si ture If the action Is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . PART 11- IMPACT ASSESSMENT obecom letedb Lead A nc A. DOES ACTION EXCEED ANY TYPE I THRESHOlD IN 6 NYCRR, PART 617.47 W yes, coonIinatB the ",yjew procoso and use the FULL EAF. DVes DNo B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negalNe declaration may be suøersedBd by anoIher InvolW!d agency. o Ves 0 No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (An.-. may be handwritten, r legible) CI. existing air quality, slllface or groundwBtør quality or quantity, noise levels, BXisting lraffic pallem, solid waste production or disposal, potential for _, drainage or IIoodòIg problems? ExplaIn briefly: I ' " ' ' I C2. Aesthelie, ogriaJltural, 8Id1aeologlcal, his1oric. or oCher natural or cultural resou.....; or COIMIIIf1iIy or neighborhood chaf3<:Ie(1 ExplaIn briefly: I I C3. Vegetalion or fauna, ftsh, s_ or wildlIfe species, slgnfficant habitats, or _ or ..oda,~ species? Explain briefty: I I C4. Î community'. existing plans or goals as _Iy adopted, or. chango in use or tntønsity of usa of land or otha' natural rasaurea.? Explain brislly: J C5. Growth, subsaquenl davelopment, or rallI18d activities tikely to be inducad by the proposed aellon? Expfain brielly: I I cs. Lf'1Q tenn. short 1Brm, cumulalNe, or oCher ""- not _ In CI-CS? Explain briefty: ,/ CT. OIlIer! inuseof_ or of D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL õl~MEÓ~IEA (CEA)? (W yes, expfain briaIIy: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAl IMPACTS? W o Ve. DNa PART IR - D~ATION OF SIGNIFICANCE (To ba completed by Agency) INSTRUCTIONS: For each adverse effect idanllfled .bova, determine whe1her it is oubølantial,laIge, important or oIherWisa significant Each effect shoUld ba assessed in connection with lis (a) selling (I.e, urban or rural); (b) probability of OCCtning; (c) duration; (d) irraversibiity; (e) geographic scope; .nd (I) magnitUde. II necassary, add attachments or reference supporting materiels, Ensure that explanations conlain sufficient detail to shoW thaI all relevant adv.... impacts have been identified and adequately addressed. II question d of part Ii was checked yes, the determination 01 significance must evaluate the potential impactolthe proposed action on the environmenlal character1slicsoltheCEA. CheCI< this box llyou have identified one or more potentlalylarge or significant adverse Impacts which MAYoa:ur. Then proceed diredlyto the FUL EAF and/or pnopare a pœitiw _lion. Check this box: if you have determined. based on the information and analysis above and any supporting dOaJmentation. that the proposed actlor WILL NOT result in any significant adverso 80_ Impacts AND provide, on _cI1ments as naœssary, the reasons supporting ttW determination. Nama of Lead Agency Dale Pnnlor Type Name of Responsible Officer In Lead Agency Title of Res~ Officer SIgnature of Responsible Offiœr In Lead Agency Signature of Preparer (If different from responsible ofticer) . . Albert J. Krupski, Presiden~. James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 530~5 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 SOUTH OLD -------------------------------------.------------------------- In the Marter of the Application of ______~~1_~~~~_'=>________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, (~l.\M I~*{¡ ))LL\t(J,~idingat Hbo7MAùJ WA.¡ b\~ 1 \~S"v Dated: q [l D l o~ r Gu"VI -1' r.tt." (signature) c::' . [,Û ). ()G,/'w....~ Sworn to before me this IOrlfday of.5"e/T;.200<l. ~ý~ 1dB..JN9A L. fSfll'. NoIIry PubIo, 8II1e III.... YtIk Suffclt CauIIIY. No. 4'IIJI3M Commlalan &pINs Mar 31, ~ 1 . . Board of Trustees Application County of Suffolk State of New York À\\~ (Þ j£..kH~O~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HFJSHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF IDSIHER 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 REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECf THE PREMISES IN CONJUNCTION Willi REVIEW OF TIllS APPLICATION. {kWl4:Þ· Igna e SWORN TO BEFORE ME TIllS z ---- DAY OF ~1,^1'\(' ,20 " ¡J. ~~ MARK T. GAGEN NOTARY PUBLIC, Stare of New vcd No,4695650 Qualified in Sdtol~ County Cea\IftiaioII ExpirBS May 31, WO 7 so&. of Trustees APPlication. .., At,-.L'11U!ÚZAT!'OK (where the applicant is not the owner) I, ,', 1} i ¡ '\: C '.\r..<' 1)\'( ~ l~ $.'ÚtT\ (print Owner of property) residing at tf.b:\ ?",Mt<\. tVlI-j-- (mai.l1ng address ;\1\ :,.\. I i ~ I 1\1" ! i/q ;\ Íi,\vL ~I ~ Y I , J i À-l\k\t'- (,i ')-~(,~{tJ~ do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. C. kJUJ ~ \8; ~..QA.., InL (OWner's signature) . . APPLICANT/AGENTIREPRESENTATIVE TRANSACflONAL DISCLOSURE FORM 'The Town ofSou1hoId's ('.t'W'II! of Ethics mohibits mnflicts of interest on the nut of1own ntTitwt and emolovr:cs.. The DUI'ÐOSIe of this fonn is to nmvide infnrimdion which can BIert the town of oossible conflicts of inœrat and allow it tD 1aIœ whatever action is nP~_rv 10 avoid same. . L , --T") ). YOUR NAME: If.' ~""!. :".. i \, t¿'I',>I't\ (Lost oame. fust oame. J¡>iddle ÜÛIiaI. unJess you .... applying in 1he name of someone else or other enti1y, such os a company, If so, iDdicaIe 1he other person's or cornpony's name,) . NAME OF APPLICATION: (Check all that apply,) Tax grievanœ VIIrianœ Change of Zone Approval of plat Exemption tiom pial or official map Other (If"Other'', Jl8Qte1he activi1y,) Do you pe~ly (or through your com~'Y, spouse. sibling. _I, or chi14) have a rehdionsbip .with lIlY officer or employee of the Town ofSoulbold? "Relationship" includes by blood, ßI&Riage, or business ihIerest. "Business in_ means a business, including a pIII1nership, in which the lawn officer or empI~ has even a partial ownenItip of (or employment by) a COIIOI'IIion in which the town officer or employee owns ItICn than 5% of the shares, Building TrusIoe Coastal Erosion Mooring Planning YES NO If you answered "YES", comp~te the ballIIIœ of this funn and date BOd sign where indicated. Name of person employed by the Town ofSouthold Title or po<ilion of that pe'"'' Describe the relationship between)'OUl1lOlf (the appIicantlagentlrc:preserllalive) BOd the lawn officer or employee. Either cbe<:k the appropriate line A) through D) ondlor describe in 1he spaa: provided. The lawn officer or employee or his or her spouse, sibling, _I, or child is (cbe<:k all that apply): _A) the owner of greaœr than S% of the shares of the corporate stock of the applicent (wheR the applicont is a corporotion); . _B) the Iega1 or beneficial owner of any inll:resl in a non-œrpcxate entity (wbeø.the applicant is not a COt'XII'8tion); . _C) an oW...... direc1or, portnei-, or employee of the app1icont; or _D) the actual applicant DESCRIPTION OF RELATIONSHIP Submitted this Signature Print Name ( 200 ¡:.. Form 1'8 I