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Home My WebLink AboutTR-4577 Glenn Goldsmith,President �W S®(/,� Town Hall Annex 54375 Route A.Nicholas Krupski,Vice President ®� ®�® P.O. Box 11799 Eric Sepenoski [ Southold, New York 11971 Liz Gillooly Telephone(631) 765-1892 Elizabeth Peeples Fax(631) 765-6641 CO BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 18, 2024 Stavros Plitas 251-16 Cullman Avenue Little Neck, NY 11362 RE: 3105 OAKLAWN AVENUE, SOUTH'OLD SCTM# 1000-70-6-8 Dear Mr. Plitas: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 17, 2024: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit #4577 from Hugh J. Murphy to Steve Plitas, as issued on March 28, 1996. 1 - - Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Si fly, 1 Glenn Goldsmith, President Board of Trustees GG/dd a a Glenn Goldsmith,Preside nth�o�pg�FFOL,�-rla Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 0 Eric Sepenoski ,? P.O.Box 1179 Liz Gillooly �y • �p� Southold,NY 11971 Elizabeth Peeples �Ol �� Telephone(631)765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection Report Date/Time: 1A Completed infield by: STEVE PLITAS requests a Transfer of Wetland Permit#4577 from Hugh J. Murphy to Steve Plitas, as issued on March 28, 1996. Located: 3105 Oaklawn Avenue, Southold. SCTM#: 1000-70-6-8 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Info needed/Modifications/Conditions/Etc.: 2 y, K nj t 5 s Cn>v,% -k PT etJ lt-,AA o e c- d Present Were: G. Goldsmith N. Krupski E. Sepenoski _� L. Gillooly E. Peeples FT Glenn Goldsmith, President so Town Hall Annex o�� U yOl 54375 Route 25 A. Nicholas Krupski, Vice President O P.O. Box 1179 Eric Sepengki [ Southold,New York 11971 Liz Gillooly G Q Telephone(631) 765-1892 Elizabeth Peeples . • O � M, (&3-1: -765=6641 olycDU '1,� in BOARD OF TOWN TR - ';�� UST EESl; �f L� TOWN OF SOUTHOLD APPLICATION FOR TRANSFER OF WETLAND PE$M� T ai o{ DATE: it3 . PROPERTY OWNER NAME: 5TIR VA0S5 MAILING ADDRESS:.. I" �U- .r(�. L:I .L,, ,.Nte!Lti PHONE: . ?. : C��V mx AGENT: PHONE ADDRESS: PROPERTY LOCATION: O. �(O,4 �(y� ��7 . TAX.MAP NO.: 7 ,�,: S� request a Transfer of Permit# ti •�i -from:.: ;I V In D �/ -�-® $ V�.oS T1.�'i --t1A Signed by: Boa. of Trustees Application AFFIDAVIT rA V S J BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF 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, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property ner Signature of Property Owner SWORN TO BEFORE ME THISDAY OF D�z6�+Ij 12023 Notary Public DIANE DISALVO ��f-r;:Pv PUBLIC-STATE OF NEW YORK No. O1 D1475593 ,,,salified in Suffolk County A,, ::.,mmission Expires April 30, 2410 I NY 025-E:eator'e Deed—Individual m Cls mflon(Single Sheet)RMI'M M CONSULT YOUR LAWYER BEFORE SIGNING THIS OCTMnMENT-THIS INSTRUMENT SHOULD HEUSED BYLAWYERS ONLY `ice de.hwe-A L13 Of 74-23 TfW INDENTURE,made the 5 day of 3,kk in the year 2023 BETWEEN JAMES PARRH..LI and JAMES P.COVEY,having an address at CIO 1575 Indian River Blvd., Suite C-120,Vero Beach,Florida 32960 as EXECUTORS PURSUANT TO�OCILIARY LETTERS TESTAMENTARY OF the last will and testament of, HUGHJ�'McSr]7n[f ,late of 8128 SE Peppercorn Court,riobe8ound,Florida 34997 ,deceased, party of the first part,and STEVE PLITAS residing at 251-16 Cullman Avenue,Little Neck,New York 11362 party of the second part, WITNESSETH,that the parry of the first part,by virtue of the power and authority given in and by said last will and testament,and in consideration of Nine Hundred Seventy Eight Thousand and 00/100--------------------------------_-.--.--_ doves, paid by the party of the second part,does hereby grant and release unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. ALL that certain plot,piece or parcel of land,with the buildings and improvements thereon erected,situate,lying and being in the Schedule A Attached hereto. Premises: 3105 Oaklawn Avenue,Southold,New York 11971 SCTM No.1000-076.00-06.00-009.000 BEINGAND INTENDED TO BE THE SAME premises conveyed to Hugh J.Murphy and Rosemary Murphy,as joint tenants by deed dated January 9,1976 recorded January 13,1976 in the Suffolk County Clerk's Office in Liber 7973 page 69 TOGETHER with all right,title and interest,if any,of the party of the first part in and to any streets and roads abutting the above described premises to the center lines thereof;TOGETHER with the appurtenances,and also all the estate which the said decedent had at the time of decedent's death in said premises,and also the estate therein, which the party of the first part has or has power to convey or dispose of,whether individually,or by virtue of said will or otherwise;TO HAVE AND TO HOLD the premises herein granted unto the party of the second part,the heirs or successors and assigns of the party of the second part forever. AND the party of the first part covenants that the party of the first part has not done or suffered anything whereby the said premises have been incumbered in any way whatever,except as aforesaid. AND the party of the first part,in compliance with Section 13 of the Lien Law,covenants that the party of the first part will receive the consideration for this conveyance and will hold the right to receive such consideration as a trust fund to be applied first for the purpose of paying the cost of the improvement and will apply the same first to the payment of the cost of the improvement before using any part of the total of the same for any other purpose. The word`party"shall be construed as if it read"parties"whenever the sense of this indenture so requires. IN WITNESS WHEREOF,the party of the first parthas duly executed this deed the day and year fust above written. IN PRESENCE OF: Ja es arrifift,Executor es .Covey,Executor Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. 4577 DATE: March 28, !996 ISSUED TO Hugh JT, Murphy Xutl ari atim Pursuant to the provisions of Chapter 615 of the Laws 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 OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS:" and in accordance with the Resolution of The Board adopted at a meeting held on March .27 19 96 , and in consideration of the sum of $ ]50.00 paid by Di~n Harold on beh~tlf:'of ttugh J. Murphy .. of N.Y. and subject fo the Terms and 'Conditions listed on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: Permit to raise house and replace foundation, construct addition to south side and porch and addition on west side and reconstru house as needed, and [n~l~e and upgrade septic system,gutters drywells as per map dated February 6, 1996 all in accordance with the detailed' specifications as presented in the originating application, IN WITNESS WHEREOF, The said Board of Trustees here- by causes its Corporate Seal to be affixed, and these presents to be subscribed, by a majority of the said Board as of this date. · ., Trustees TERMS ,,,nd CONDITIONS The Permitter Hugh J. Murphy Pine Neck Road, Southold re*iding at part of the comideration for the issuance of the Permit do~ understand and pres~ihe to th* fol- lowing: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or clam for damage*, of suits arising di~-'tly or indire~ly as a result of any oper- ation [grfotmed pursuant to this permit, and the said Permit'tee will, at his or her own expense, defend any and all such suits initiated by third parties, and the said Permittee assumes full liability with respect thereto, m the complete exclusion of the Board of Trustee, of the Town of Sonthold 2. That this Permit is valid for a pexind of 24 mos. which is coa~ides~ to he the estimated time required to complete the work involved, but should drcumstances warrant, reque*t for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permitree wishes to maintain the structure or proiect involved, to provide evidence to anyone concerned that auth- orization was originally obtained. 4. That the work inwdved will be subj~-t to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating appliratioa, ma)' he cause for revocation of this Pemiit by resolution of the said Board. 5. That Ehere will be no unreasonable interference with navigation as a result of the work herein aothorized. 6. That there shall be no interference with the right of the public to pass and repass along the beadt between high and low water marks. 7. That if ~umre operations of the Town of Southold require the removal and/or alterations in thc location of the work herein authorized, or if, in the opinion of the Board of Trustee*, the work shall cause unreasonable obstrucuon to free navigation, the said Permirtee will be requilred~ upon doe notice, to remove or alter this work or project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permitter ot the completion of the work auth- orized. 9. '[l~at the Pcrmittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. DIANE HEROLD, ARCHITECT P.O. Box 884 Westhampton Beach, June 17, 1996 New York 11978 Mr. Albert J. Krupski, President Board of Town Trustees Southold Town Hall P.O. Box 1179 Southold, New York 11971 RE: Hugh J. Murphy permit no. 4577, March 28, 1996 Dear Mr. Krupski and Town Trustees: In reviewing the permit issued by your board, I found the address was incorrectly shown as Pine Neck Road. Mr. Murphy's property is located at 3105 Oaklawn Avenue. Please issue a revised permit if you feel it is necessary. Mr. Murphy has requested me to contact your board regarding another matter. When Mr. Murphy filed an application with your board, he was planning to renovate the existing house and build an addition on the east and south sides of the house. In opening the house for the season, Mr. Murphy took a critical look at the existing house and felt there was not much to save. He would be interested in razing the existing house and building a new house in the footprint provided by the existing house and two proposed additions. The final design of the house would be the same, but in one case, it would consist of all new materials and in the second case, the house would consist of new and old materials. I have spoken to the Building Department, and they have no objection to building a new house as long as all the permits that have been issued are amended. Therefore, we would like to know whether or not the approval we received from your board would cover the demolition of the existing house and the building of a new house to the proposed footprint originally granted. Thank you for your attention to this request. Diane Herold Albert $. Krups/d, Pres/dent John Holzapfel, Vice President Jim King Mardn H. Gm'ell Peter Wenczel 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 March 28, 1996 Diane Herold, Architect P.O. Box 884 Westhampton Beach, NY 11978 Re: Hugh J. Murphy SCTM # 70-6-8 Dear Ms. Herold: The following action was taken by the Board of Town Trustees during its regular meeting held on March 27, 1996 regarding the above matter: WHEREAS, DIANE HEROLD on behalf of HUGH J. MURPHY applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 7, 1996, and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WB~EAS, a Public Hearing was held by the Town Trustees with respect to said application on March 27, 1996, at which time all interested persons were given an opportunitytobeheard, and, Wh~d~AS, 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 s,,h~itted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 37-18 of the Southold Town Code, 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 grant a Wetland Permit to raise house and replace foundation, co~tz~/ct addition to south side and porch and addition on west side and reconstruct house as needed, and move and upgrade septic system, gutters and dr~ells as per map dated Februa~ 6, 1996. and, BE IT FUR'£~ ~SOLVED that this determination should not be considered a determination made for any other Department or Agency which may also have an application pending ~or the same or similar project. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued with_in six monte of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None. Very truly yours, Albert J. F~rupski, Jr. President, Board of Trustees AJKljmd cc: CAC Telephone (516) 765-1801 Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11973- SOUTHOLD TO~N CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held March 25, 1996 the following recommendation was made: 1333 Moved by Allan Connell, seconded by John Hagerty, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH CONDITIONS of the Wetland Application of HUGH J. MURPHY 70-6-8 to (1) Raise existing house to required FEMA elevation. (2) New Pile foundation to replace deteriorating foundation of locust posts and stacked concrete blocks. (3) Proposed addition on south side of existing house. (~,) Proposed porch and addition on west side of house. (5) Possible rebuilding of approximately 10 feet of west side of existing house if found to be in deteriorated condition. The CAC recommends approval with the condition that the applicant put silt fence or staked hay bales around the perimeter of the property to prevent sedimentation. Oaklawn Avenue, Southold Vote of Council: Ayes: All Motion carried. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 $outhold, New York 11971 Telephone (516) 765-18~r2 F~x (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF $OUTHOLD March 25, 1999 Diane Herold, Architect P.O. Box 884 Westhampton Beach NY 11978 RE: HUGH J. MURPHY SCTM #70-6-8 Dear Ms. Herold, The following action was taken at the $outhold Town Board of Trustees Regular Meeting on March 24, 1999 RESOLVED, that the Southold Town Board of Trustees approve the request for a second and last, one year extension on Permit #4577 to raise the house and replace foundation, construct additions and move and upgrade septic system. This extension will expire March 28, 2000. If you have any questions, please contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. DIANE P.O. Box 884 Westhampton Beach, February 26, 1999 HEROLD, ARCHITECIuLIL TI,I ,,l New York 11978 Board of Town Trustees Town of Southold Town Hall 53095 Main Road Southold, New York 11971 RE: Hugh J. Murphy SCTM ~70-6-8 Dear Board Members: On behalf of my client, Hugh J. Murphy, I am requesting of Permit ~4577. This request is over a year to obtain a permit for the sanitary system from the Suffolk County Department of Health Services. Because the lot is small, and the properties in this area have private wells and sanitary systems, the project had to be approved by the Board of Review in the health department. We have just received this permit for construction and have filed an application with the Town of Southold Building Department. We regret the delays that have been incurred but are planning to start construction upon the issuance of a building permit. Thank you for your attention to this request. Sincerely, Diane Herold enc. Albert J. Krupski, President Jame~ King, Vice-President Henry Smith Artie Foster Ken Poliwoda TownHall 53095Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 26, 199S Diane Herold, Architect P.O. Box 884 Westhampton Beach NY 11978 TOV',,'N RE: HUGH J. MURPHY SCTM #70-6-8 Dear Ms. Herold, The following action was taken at the $outhold Town Board of Trustees Regular Meeting on March 25, 1998: RESOLVED, that the Southold Town Board of Trustees approve the request for a one-year extension to Permit #4577 to raise the house and replace foundation, construct additions, move and upgrade septic system. Permit to expire March 28, 1999. If you have any questions, please contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Pol/woda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-18~2 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD March 26, 1997 Diane Herold, Architect P.O. Box 884 Westhampton Beach NY 11978 RE: HUGH J. MURPHY SCTM #70-6-8 Dear Ms. Herold, The following action was taken at the Southold Town Board of Trustees Regular Meeting on March 25, 1998: RESOLVED, that the Southold Town Board of Trustees approve the request for a one-year extension to Permit #4577 to raise the house and replace foundation, construct additions, move and upgrade septic system. Permit to expire March 28, 1999. If you have any questions, please contact our office at 765-1892. Sincerely, Albert J. Krupski, Jr. - President, Board of Trustees AJK/dJh cc. Bldg. Dept. DEPARTMENT OF HEALTH SERVICES March 5, 1998 COUNTY OF SUFFOLK TOWN OF SOUIH .; ROBERt J. GAFFNEY SUFFOLK COUNTY EXECUTIVE CLARE B. BRADLEY, H.D., M.P.H. ACTIN(~ COMMISSIONER Ms. Diane Herold PO Box 884 , ~ ~. ,.. ,¢ Westharnpton Beach, NY 11978 Subject: Rl0-97-67~ Property $~E/C Oaklawn ~4vem~e and Jockey Creek, (T) Southold; $CTM: 1000-70-6-8 Dear Ms. Herold: Enclosed is a copy of the Board of Review's findings, recommendations and determination concerning the subject application. Based on the information submitted, the Board granted the request for variance with the provisions indicated in the determination. The granting of this waiver does not imply that your application will be automatically approved. It is your responsibility to ensure that your application is complete; otherwise, your approval will be subject to unnecessary delay. Board of Review jcm.kcn enclosure. cc: Board of Review - Riverhead James Bagg Hugh and Rosemary Murphy Albert J. Krupski, Jr. Royal R. Reynolds, P.E. Roy Dragotta, Esq. Article 2, Section 220, Suffolk County Sanitary Code To: ~:rom: Subject: Clare B. Bradley, M.D., M.P.H. Acting Commissioner of Health Services James C. Maloney, P.E., Chairman, Board of Review Report of Findings and Recommendations of the Review Board Regarding: RI0-97-67, Property S/E/C Oaklawn Avenue and Jockey Creek, (T) $outhold; 8CT3I; 1000-70-6-8 Applicant: Diane Herold PO Box 884 l/Vesthampton Beach, NY 11978 Notice of Hearing: February 3, 1998 Hearing Date: February 19, 1998 Statement of Problem Applicant is requesting a waiver from construction standards that require a separation distance of 150 feet between a shallow well and a septic system. Findings and Facts 1. Site is in Groundwater Management Zone #IV. 2. Area is zoned residential. 3. Public water is not available. 4. Depth to groundwater is approximately 6 feet. 5. Soils are acceptable. Applicant ~vishes to utilize the existing septic and water supply systems to serve the proposed home after the existing home is demolished. Though the levels of contaminants within thc water sampled from a test well were acceptable, the presence of nitrates, chlorides and sodium were detected at appreciable levels. Determination By a vote ors to O~ the board det?mined to at, prove the applicant's request for a waiver from the department's requirement for minimum distance from the leaching pool of a septic system to a shalloxv xvell; however, the applicant must covenant the property, in language acceptable to the County Attorney, that the on-site well and sewage disposal system do not meet departmental requirements. Date n;s C. 1V~alon;yfP.E~,///,-,efhairman DIANE HEROLD, ARCHIT! P.O. Box 884 Westhampton Beach, February 19, 1998 New York 11978 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, New York 11971 RE: Hugh J. Murphy Permit ~ 4577 Dear Mr. Krupski and Board ~embers: On behalf of my client, Hugh Murphy, I am requesting an e~~o the above permit which expires March 28, 1998. On January 10, 1997, I tried to file an application for ap~.roval to construct sewage disposal with the Suffolk County Department of Health Services. I was asked to submit additional information which was done on March 21, 1997. Subsequent requests from that department dated 4/17/97 and 9/3/97, resulted in the necessity of filing an application for variance or waiver from regulations or specifications on October 10, I997. The Board of Review was held this morning, at which time we were informed that a decision would be mailed to us in four to six weeks. This does not permit enough time for us to file an application with Suffolk County Department of Health Services for any upgrades they require nor to file for a building permit with the Town of Southold. In view of these circumstances, an extension of your permit is re~u~d. I have enclosed copies of the correspondence with the health department. If you need additional information in order to act upon t%is request, please contact me. Thank you for your attention to this matter. Sincerely, Diane Herold enc. WWM-059 (F{FV. 7/94) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES OFFICE OF WASTEWATER MANAGEMENT.: COUNTY CENTER~ RIVERHEAD~ NEW YORK; 11001, .. · .516~52.2!00 . . ..,~ * .: '.,'.~' ^.puc^,',o. FOR^PP.Ot;^Li O '. '"' .. · ,..,-.., ..,, ,.. RUC,r AND WATER SUPPLY FACILITIES' FOR SINGLE!I Before completing this application refer to Bulletin WWM-04~. ("Sub0' PLEASE t. NAME OF APPLICANT ADDRESS Dwellings") PHONE .~~ 2. NAME OF AGENT (IF NOT APPLICANT) ,~,.~rh~; ~,c · 13, tt~..~'-, ..... _ .:~;' ADDRESS 3. NAME OF CURRENT PROPERTY OWNER (IF NOT APPL CANT) ~U6ld:lo,~Jt-d 4. DESIGN PROFESSIONAL ~ J~E H~ ~¢NIY~7 5. TAX MAP NUMBER: DISTRICT /OO0_ SECTION 70 , BLOCK _. ~'~:, N/~ SIDE OF ~ '~10~ OA~L~ AND TOWN. PRIVATE WELL pUBLIC SEWER 6. PHYSICAL ADDRESS; ~g:3.~GFEET(~S/E/WOF '~l~- IOEd./r~ N/S/E/W CORNER OF HAMLET ~---~ t ) 7'~_[ ~ 7. SUBDIVISION NAME & LOT NUMBER (if any) 8. PROPOSED WATER SUPPLY: (CHECK ONE) 9. PROPOSED SEWAGE DISPOSAL: (CHECK ONE) 10. PROPOSED NUMBER OF BEDROOMS '-/H~.E'C~ · 11. Are any of the following permits/approvals required? (CHECK) a) Welland permil - NYSDEC/TOWN? Ix'] YES [ ] NO b) Zoning variance - TOWNNILLAGE? [.~.] YES ' [ l NO PUBLIC WATER ON-SITE SYSTEM Applicalion is hereby ma~e for a permit to construct a water supply and sewage dispo,~l ¢fystem for a single family residence in accordance with this application, surveys and plans subn'~itted. I hereby.'gartifY that I have exah dned this complete ~.)plication and Ihs statements therein are true and correct, and that.all work shall be done in accordance with all applicable Town, County, State and Federal Laws and Codes. "Ar~y false statement made heroin is punishable as a misdemeanor pursuant to S210.45 of New York State Per, al Law." SIGNATURE t~.-~'~.40..'~.-z F - .,tdJ DATE .~"JLJAiE¥ ~ jC~-~._ PRINT NAME "-t"~l P,N¢~ H~-O.L-"L-'~ DATE _,~PJJOi~ THIS APPLI.C_~TION MUST BE A_CCOMLPAN!ED B¥_~EQUff].E-D-~~D-~E-FS DIANE t[EROLD, ARCtliTECT P.O. Box 884 Westhamtpon Beach, March 21, 1997 New York ]1978 Mr. Roy Reynolds Bureau of Wastewater Management Suffolk County Department of Bealth County Center River}lead, New York 11901 Services RE: tlugh Murphy and Rosemary Murphy 3105 Oaklawn Avenue, Southold tax map 1000-070-6-8 Bear Mr. Reynolds: On January 10, 1997, I discussed tile above property with you. After working with the boards of tile Towu of Southold, fir. Murphy has received permission to demolish his existing house and build a new one. As we discussed, there is some concern in this area regarding water quality arid tile location of sanitary systems. Mr. Murplly has spoken to his plumber, who agreed with your department that the w, ter quality from Mr. Murphy's well is unsatisfactory. In fact, Mr. Murphy has used bottled water for the twenty years that he has owned the house. blt. Murphy is eager to build. I have discussed with that your department may require convenants on the property and/or condition~ng of the well water or a relocation of either the well or sanitary system. Mr. Murphy works in the plumbing Industry and is fully aware of products that are avaiab]-:, lie has indicated to me that any and all conditions that your department may impose upon this project a~e acceptable to him. 'FO assist you in your review of this request to either retain tile existing we.Il an(] sanitary system or to redesign tBese systems, [ have euclosed the fo] ]ouing documentation: Mr. Roy Reynolds t-larch 21, 1997 pa(je two A survey of A s~lrvey of well and sanitary system located A survey of tile neighboring property to tile well and sanitary system location as A SCI)lIS application for a single family dwelling test hole data by McI)onald Geoscience tile existing conditions and house location the proposed house location with the existing the south with indicated by the owner Informatiot from ~-Iorris Cesspool Zoning Board of Appeals approval, Hoard of Town Trustees approval. ['JYS I)EC lette¥ Service [nc. Town of Southold Town of Southold of no jurisdiction you wish Lo discuss LIlis ilIft;l~llldtJon t~iLh mu, I may reached ~t 2tlH-5Ozl9. 'l'hanl{ you for your attentioll to this reqnesL. sincerely, I)i ~,nt~ Ilerol d WWM-042 (Rev. 1/92) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES OFFICE OF WASTEWATER MANAGEMENT SUFFOLK COUNTY CENTER · ,,-----R~VERHEAD NEWyORK 11901 . . 516_852_2100 ' · NOTICE OF INCOMPLETE APPLICATION L RESIDENTIAL / H.S REFERENCE NO.: ~t0- 97- 0067 PROPERTY LOCATION: ne;( t. ,n~,,t ~'-er The plans for your proposed sewage disposal and water suppl~' systems have been reviewed and the following will be required prior to furtherpnacess'n~ of the .applicati°n for appnaval to cgnstruct. PLEASE RETURN A COPY. OF THIS FORM WITH ANY RESUBMISSIO~. NOTE:%CHANGE~ST BE MADE ll~ A LICENSEi~ DESIG~PROFESSIONAL'ff.E.. SURVEYOR. ARCHITECT OR ENG~"~IE~R.~I. 1. pRELIMINARY APPROVALS - OTHER AGENCIES [ ] N.Y.S. Dept. of Env. Cons [ ] Sewer District Appna~'al [ ] Town Wetlands/Drainage/Zoning [ ] S.C.D.H.S. Vector Control H. PLAN DATA AND INEORMATION REOUIRED [ ] SEQRA Determination [ ] Other [ ] 3 prints of~Jlan required with design~,~lndicate on plan t~e slmcific ' [..] Indicate any surfage walers within professional's original stamp and · location(s) [with r~easurements] of all 300' of plot; show wetlands limit water supply wel!~. & .~p,t!c systems as flagged by NYSDEC and/or ] (within 150' of ~[l~prop'erty lines) or' Town ] state if dwellings are connected to , ] public water 01- o ~,~s'S"r ?') [ ] Show area lbr 50% expansion of ] [ ] Show proposed house/driveway sewage disposal system ] location on plan '~Show proposed sewage disposal [ ] Show test boring & location on 1 ] system/water supply well/water plans improved (within 150' of all x . service line on plan property lines) ~ Test well required.nih your lot as per [ ] Test boring inadequate. See [ ] Retaining wall must be designed by attached bulletin (..L) Remarks below. . .. RE. or R.A. ~ [ l' G(adin~ p[gn sh~wing inv.eri' J ~[ '? Submit'letter r/-6fii water ~hstnc[ indicating distance to nearest public system, tbundation and final grade water main and availability .... .- (by licensed design proli~ssional) HI. ~ [ ] Public sewer stub location from ~ sewer district shown on plans signature , - Application Fee: $ Name, address, phone no. required Statemei~t signed by applicant Indicate area of lot (sq. ft.) Corner ale, yations · .C. Ta~.~Mi~p Number required Surrounding property-vacant or FURTHER INFORMATION MAY BE REOUIRED l~atePrep~ired L~)lq/~'~l By (~""~ /'~VO~.)J' No. WWM-043 (Rev. 10/87) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES OFFICE OF WASTEWATER MANAGEMENT SUFFOLK COUNTY CENTER RIVERHEAD, NEW YORK 11901 516-852-2100 NOTICE ~OF~NON-CONFORMAN~CE - RE~;IDENTIAL H.S REF. NO.: ~ i (j ~ c~'~_ PROPERTY LOCATION This application is not being processed for approval as submilted because it does not appear to conform with the standards/requirements of the Suffolk County Sanilary Code as indicated: 1. ~ ', T_he installation of a subsurface sewage disposal system~) is not permitted w_hea~: , , The proposed system will be !ess than 100 feet from neighboring well(s); proposed well; surface waters and/or wetlands· : ~ The existing subsoils on the site contain meadow mat, bog, silts, clays or other impervious materials which extend bek, w the groundwater table or existing subsoils in the area are unsuitable for the proper functioning of the system. ~5 The groundwater or drainage conditions are unsuitable for the proper functioning of the system· , ) The population density equivalent exceeds the limit of one single family residence per one-half acre and/or one acre. ,: ~ A public sewer system is available. 2. (, The installation of a private water supnly well is not permitted when..'. , ) A public water supply is available. ~ ~ The groundwater supply in the area is inadequate for individual water supply wells. L: The proposed well will be an insufficient distance from proposed or existing sewage disposal system(s). 3. ,: ) The parcel(s) being applied on are apparently part of a realty subdivision or development, as defined in Article 6 of the Suffolk County Sanitary Code, which has not been approved by the Department for the method of sewage disposal and water supply. Prior to further processing of the application, it will be necessary that the owner(s) of the overall property file a realty subdivision or development map with this office. 4. ,) The proposal is not in conformance with the conditions of the approved realty subdivision or development map. 5. ~ Othe_~/Comments; If this matter cannot be resolved, you may request a variance from these standards by applying to the Department's Board of Review (forms and instructions enclosed)· Prior to applying to the Board of Review, the residential application must be completed· IFOR DEPARTMENT~Y Date Prepared q/3 / ~ .~ Reviewer DIANE HEROLD, ARCltlTECT P.O. Box 884 Westhampton Beach, September 2, 1997 New York 11978 Roy Reynolds Suffolk County Department of Health Services Office of Wastewater ManaGement Suffolk County Center Riverhead, New York 11901 RE: H.S.REF NO. R10-97-0067 Oaklawn Avenue,J'Southold SCTM ]000-70-6-8 Dear Mr. Reysolds: Enclosed are the following items{ tax map showing the location of the sanitary system and well of tile property to the west of the subjuct parcel three copies of the site plan showing tile proposed water and sanitary system lines a copy of the test report regardinG the existin§ well water at the subject property. The work was performed by Mr. Murphy's plumber under my supervision. Please contact me if additJonal information is required by your department because Mr. Murphy would like to [)real{ 9round this fall. Sincerely, Diane Herold enc· L/93) SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES BOARD OF fCEVIEW SUFFOLK COUNTY CENTER RIVERHE~J3, NEW YORK 11901 APPLICATION FOR VARIANCE OR Ti): Chairman of the Review Board I, We, Diana_tLerold,~r_chl~eck~_£~r Huglk~nd_Roauma£y M~l~hy fas[ding/doing business at (mailing addres~)__~Q, Dog 88~, · ~,lue~t a variance IX ] or waiver [ ] from (indicate Article & Section , of thu (cross one out) Nm~c=~D~]~uu~ml~Suffolk County Sanitary Code, and ia in re~erence to (indicate Health Services Reference Nu~tber, name of proposed realty subdivJsion/deve]opment and Suffolk County Tax Map Nuu~er) HS ~ef No R]0-97-0067 SC'PM 1000-70-6-8 Bi.[el explanation of why var/ance/waiver should be granted --~r-_~ur4Ahy h~s recaiued_peruaissLon to . a_na~t_llQ~a~_aJi_hia_~rQR~£kY-_a~ ~]05 o~kl~wn Avenu~ Southold. _..ru~u~ka_~mlsalQn to .r~ai~exla~!!_~nd sanitar~ rebuild lie n~_mlor~ui ~ah]~--l~'=tiQn~__~/an be fokHlf/.,~__il~_ha~ jlro~l~_ed__docLlmen tat i on _ I_.lidC_Lhe ~x[~_~l/lo.._~3~/.~Lq~ ~Fe ad__g~b~a_~te___fo.r a_!!99se with tile same number t,f bedrooms as the exi~ttll9 house. D~tu o~t._o~_r_]_Q, 19q7 Signature(s) L'L i iLL Name (s) _[/l~ll =.Lllef_o]_~ ~__Archi tect I. 'l'yp~ or print l~3iL, ly and uubmit completed fo~Lu to the address at Lop ~,l c~[q~l. JCdtJOll. i~_ RE(/ARDLESS OF ANY PRIOR S[IBt4ISSION, YOU MUST ENCLOSE WITH THIS APPLIC~ATION ,~. t:tq,~, ok sur'v=¥ f~k Jesidentia]. constxuctitJn, site plall for coJimLercJul CERTIFIED CIIECK OR MOIlE)[ ORDER FOR $450.00, HADE PAYAI~LE TO SIJ~'~'OI,I{ ENVIROtlMEIi~'A[, IIEAI,~'ll. .liLt[ plctt;~ ~or tliu hUal in,t. ',. 'l'h~: lit:ak ill,J wi I I l,t: z~.h~dtllc:,[ ,ia Zi.im du ft,t,aztil,lt~; h,,~c:v~J:, ;il I h¢~,t, ii,,l SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES OFFICE OF WATER AND WASTEWATER MANAGEMENT SUFFOLK COUNTY CENTER RIVERHEAD, NEW YORK 11901 516-852-2100 NOTICE OF INCOMPLETE VARIANCE REQUEST - BOARD OF REVIEW FILE REF: The request for a Board of Review hearing has been received. Prlc, ' ' . this office will ......... :,~ ~ ,,.,-I~e-eubm~tted. Variance Application Fee $ Environmental Health). Public water or sewer availability/cost letter. Test hole data. Test well results. Site plan. Proposed sewage disposal: [ ] Location , ] Grading plan (pl;~n view and cross section). NYSDEC wetlands permit or waiver. SEQRA determination letter from Town/State. Completed subdivision/commercial/residential application. , Other (check or money order made payable to Suffolk County WWM 062 (REV. 9193) Following receipt of all requested information, hearings will be scheduled at /he earliest ilyallable date. Please do not cell thi_i.i.i.i.i.i.i.~lce wilh requests for earlier scheduling. PLEASE RETURN THIS FORM WITH YOUR RESUBMISSION. - - DEPARTMENT OF HEALTH SERVICES COUNTY OF SUFFOLK ROBERt J. GAFFNEY SUFFOLK COUNTY EXECUTIVE CLARE B. BRADLEY. M.D., M.P.H. ACTING COMMISSIONER February 3, 1998 Diane Herold P.O. Box 884 Westhampton Beach NY 11978 Dear Ms. Herold: Subject: R10-97-67, Property S/E/C Oaklawn Avenue and Jockey Creek, (T) Southold; SCTM 1000-70-6-8. Your request to appear before the Board of Review of the Suffolk County Department of Health Services has been received. The review of this case has been scheduled for February 19, 1998, at 11:30 AM, in the Suffolk County Department of Health Services Conference Room, County Center, Room S-238, Riverhead. You and interested parties are requested to appear, with or without counsel, and you may produce any information or evidence concerning the above referenced property. Should you have any questions, please call (516) 853-3081. Very truly you,rs, James C. Maloney, P.E. Chairman, Board of Review JCM/Ir CC: Martin TreH[ James Pim, P.E JaiHes Bagg Hu§h and Rosemary Murphy Albert J K~up~k~. Jr. Royal R. Reynolds, P E 225 RABRO DRIVE EASI HAUPPAUGE NY 11788-4290 · IELEPtIONE (516) 853-3079 · FAX (516) 853-3075 L owN o[ SOUT,OtD.] DEPARTMENT OF HEALTH SERVICES COUNTY OF SUFFOLK ROBERT J. GAFFNEY SUFFOLK COUNTY EXECUTIVE CLARE B. BRADLEY, M.D., M.P.H. ACTING COMMISSIONER February 3, 1998 Diane Herold P.O. Box 884 Westhampton Beach NY 11978 Dear Ms. Herold: SubJect: R10-97-67, Property S/E/C Oaklawn Avenue and Jockey Creek, (T) Southold; SCTM 1000-70-6-8. Your request to appear before the Board of Review of the Suffolk County Department of Health Services has been received. The review of this case has been scheduled for February 19, 1998, at 11:30 AM, in the Suffolk County Department of Health Services Conference Room, County Center, Room S-238, Riverhead. You and interested parties are requested to appear, with or without counsel, and you may produce any information or evidence concerning the above referenced property. Should you have any questions, please call (516) 853-3081. ry truly yours, Maloney, P.E. Chairman, Board of Review JCM/Ir CC: Martin Trent James Pim, P.E. James Bagg Hugh and Rosemary Murphy Albert J. I(rupski. Jr. Royal R. Reynolds, P.E. 225 RAaco DElE E~sr HNJ~PNJGE NY 11788-4290 · TELEPHONE (516) 853-3079 · F~X (516) 853-3075 m ~q m ROANOKE AVE. Telephone Town Ha11.53095 Main Road P.O. Box 1179 Souchold. New York 1197t SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL JOL G The following recommendation was adopted at the July 29, 1996_meeting of the' Southold Town Conservation Advisory: A-69 Moved by Bruce Loucka, seconded by John Hagerty, |t was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH STIPULATIONS of the Amendment to Permit Request of HUGH J. MURPHY 70-6-8 to totally reconstruct house instead of partially reconstruct. Oaklawn Avenue, Southold The Council recommends approval with the stipulations that hay bales be used during construction to prevent runoff into the creek from the area that is not bulkheaded, and that there be a 10' non-turf buffer behind the bulkhead. Vote of Council: Ayes: All Motion carried. Albert J. Krupski, President $ohn Holzapfel, Vice President Jim King Martin H. Gan'ell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 1996 Diane Herold P.O. Box 884 Westhampton Beach, NY 11978 RE: Hugh J. Murphy Permit ~4577 Dear Ms. Herold: The above referenced Permit was reviewed. An amendment is not needed as the proposed work fits within the description of permit #4577. If you have any further questions, please do not hesitate to contact this office. Albert J. Krupski, Jr. President, Board of Trustees AJK: jmd DIANE HEROLD, ARCHITECT P.O. BOx 884 Westhampton Beach, New YOrk JUly 26, 1996 11978 Board of Town Trustees Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 RE: Hugh J. Murphy 3105 Oaklawn Avenue, trustees oermit 4577 Dear Mr. Krupski and Board Members: Thank you for your prompt response to our request to amend the above permit. In view of the extremely poor condition of the existing house and the fact that no interior wall will remain in its existing location has made Mr. Murphy decide to demolish the existing house and rebuild in the exact footprint as originally proposed in the previous application. We are requesting an amendment to the above application. The six foot addition on the west and the twelve foot addition on the south side of the existing house are still proposed but will become part of the construction of the new house. The additional change will be the existing house will be rebuilt as a 1-1/2 story house. A revised survey is attached which shows that the footprint of the new house is the same as the existing house with the proposed additions. If you need additional information, please contact me at 288-5049. Please note that the address for tho project is Oaklawn Avenue and not Pine Neck Road. Thank you for your attention to this request. Sincerely, Diane Herold enc. Albert J. Krupski, President John Holzapl'el, Vice President Jim King Martin H, Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTIIOLD Town ttall 53(D5 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 March 28, 1996 Diane Herold, Architect P.O. Box 884 Westhampton Beach, NY 11978 Re: Hugh J. Murphy SCTM # 70-6-8 Dear Ms. Herold: The following action was taken by the Board of Town Trustees during its regular meeting held on March 27, 1996 regarding the above matter: WHEREAS, DIANE HEROLD on behalf of HUGH J. MURPHY applied to the Southold Town £rustees for a permit under the provisions of the Wetland Ordinance of the Town of $outhold, application dated March 7, 1996, 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 March 27, 1996, 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 docmnentation submitted concerning this application, and, WHEREAS, the structure complies with the standard set forth in Chapter 37-18 of the Southold Town Code, 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 grant a Wetland Permit to raise house and replace foundation, construct addition to south side and porch and addition on west side and reconstruct house as needed, and move and upgrade septic system, gutters and drywells as per map dated February 6, 1996. and, 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 ~or the same or similar pro3ect. Permit to construct project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees are to be notified upon completion of said project. FEES: None. Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/jmd cc: CAC Albert J. Krupski. President John Holzapfel, Vice President William G. Albertson Martin H. Gan'ell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 office Use Only Coastal Erosion Permit Application ~--Wetland Permit Application Grandfather Permit Application Trustee Lands Permit Application Waiver ~/~/~ ~Received Application: 0 ~Clerical Review: ~/?/~. --Completed Applica~i~ Incomplete · SEQRA Classification: Pype I .Type II_~__Unlisted__ ~rdination: (date ~gn~)__ ~"CAC Referral Sent: ~/?/~ ~?-Date of Inspection: ~/~/~6 ~--~eceipt of CAC Repor~:~ate) Lead Agency Determination: Technical Review:(date) _ ~-Public Hearing:(date) ~/~?/~ Decision: Approved (Y/N) '(date) ~_=Application Fee:%/~-~. /~ Name of Applicant ~g~ ~. ~tU~¢¢~ Address ~U~U~ -r~hBo~ ~to yo~l¢ 10707 Phone Number:(91~) q~l- 9Z~7 Suffolk County Tax Map Number: 1000 O7o- ~- ~ Property Location: ~/~ O~L~J A~(JE ~OO~H oF (provide LILCO Pole ~, distance to cross streets, and location) Agent: '~%~ (If applicable) Address: 1 t , .. ~d of Trustees Applicatio~ GENERAL DATA Land Area (in square feet): Io~ IOo~ Area Zoning: Previous use of property: Intended use of property: 9.-'---/0 Prior permits/approvals for site improvements: Agency Date 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): of Trustees Application' WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~S6 Hoo$6 om Area of wetlands on lot: ~ square feet Percent coverage of lot: ~O. J % % Closest distance between nearest existing structure and upland edge of wetlands: ~ feet Closest distance between nearest proposed structure and upland edge of wetlands: %7 feet Does the project involve excavation or filling? ~( No Yes If yes, how much material will be excavated? How much material will be filled? Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: z~. cubic yards cubic yards Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate): '! ~R~3JECT I.D. NUMBER 617.21 SEQF Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only =ART I--PROJECT INFORMATION (To be completed by Applicant or Project sponsor) f. APPLICANT /SPONSOR I 2. PROJECT NAME 3. PROJECT LOCATION: Municipality 50 ~'"~ HO L.~:~ County 4. PRECISE LOCATION (Street address and road intersections, prominent ~andmerks, etc., or provide map) 5. IS ~ROPOSED ACTTON: ~ New ~ Expansion ~ Modification/alteration ' ' 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF ~ND AFFECTED: lnilially O · ~ acres Ullimately O. ~ acres 8, WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] Yes [] No Il No, describe briefly g. WHAT IS PRESENT LA~ID USE IN VICli'~ITY OF PROJECT? J~Res.dentlal [] ?ndustrial [] Commercial Describe: [] Agriculture []ParklForesuOpen space []Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDIfJG, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes [] No It yes, llst agency(s) and permll/approvals 11. DOES ANY ASPECT OF THE ACHON HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [~ t'fo it yes, list agency name and permltlapproval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? Yes f CERTIFY THAT THE INFORMATION PROVIDED ABOVE iS TRUE TO THE BEST OF MY KNOWLEDGE I! the action is in the CoDstal Area, and you are a state agency, complete the Coastal Assessment Form belore proceeding with this a~.,~,essment OVER 1 B~d of Trustees Applicat] County of Suffolk State of New York BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. swo~ TO BEFORE ME THIS 7~ DA~ OF ~, ,19 ~ Notary Public EDYTHE V; MULLEN NOTARY PUBLic, State of New Yo"k, No. 4895193 Qualified in Suffolk County COmmission Exp,res May 26, 19 ~17 PART II--ENVIRONMENTAL ~BESSMENT (To be completed by Agency) ' ' A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 II yes, coordinate Ihe review process ane use the FULL DAF. [] Yes [] No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another Involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwrilten, if C1. ExlsUng air quality, surface or groundwater quaiily or quantity, noise levels, existing Irafflc patterns, solid wasle production or disposal potential for erosion, drainage or flooding problems? Explain briefly: C3. Vegetation or fauna, fish, sheghsh or wlldUfe species, significant habilals, or threatened or endangeree species? Explain PrieUy: C6. Growth, Subsequent development, or relaled aclivltJes IIkery to be Induced Dy the proposed action? Explain bdeUy. C6. Long term, Short term, curnuJalive, or other elfeclS not Identified in C1.C57 Explain briefly. C7. Other impacts (including changes In use OI either quantity or type of energy)? Explain Drlelly. O. IS THERE, OR IS THERE LIKELY TO SE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] NO If Yes, explain briefly PART III--DETERMINA:I'ION OF SIGNIFI(~ANCE (To be ~ompleted by Agency) INSTRUCTIONS: For each adverse effect idenfiiied above, determine whether it ia substantial, largo, Important or otherwise significant. Each effect should be assessed In connection with its (a) setting (i.e. urban or raral); lb) probability ot occu~.[ng; lc) duration; (d) Irreversibility; (e) geographic scope; and {t) magnitude. U necessary, acid attachments or reference supporting materials. Ensure thai explanations conlain 6ufficient detail fo show that all relevant adverse impacls have been identilJed and adequately addressed· [] Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive, declaration. [] Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action WILL NOT result in_~ny significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: