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Home My WebLink AboutTR-5761Board Of Southold Town Trustees ISSUED TO ............ -~A~.U. EL....LAN'N~.-DE..L. UG~ ........................................ ntl rizalinn Pursuent to the provisions of Chapter 615 of the L~ws of the Stale of New Yor~, 1893; and O~pter ~)~ of ~e State of New Yo~ 19~21 and ~e~ ToWn ~ina~e t~ ."R~U~TIN~ AND ~E P~OlN~ OF OBSTRUOTIONS IN AND ON TO~N ~ATERS AND PUBLIC ~DS REMOVAL ~ SAND, ~VEL OR O~ER MATERIALS ~OM ~NDS UNDER TO~N'WA~RS;~. a~ in acc~a~e ~th the Res~ion of ~e ~ard adopted at a meeting ~ on -~y"--2~-~ ....... ~0~......, and'in consideration of the ~m of $.-.2~O.0~ ....... ~id .... ~ ~el...&..,An-ne---De~uca .................................................................. : ............ ......... of ...... ~.~.?.~.~ ........................................................ N. Y. ~nd. ,ubj~t to the Te~ and ~nditi~s ~ on ~e reve~ ~e ~f, of ~ Town Tr~s ~h~izes ~nd ~s ~ Wet~d P~t to ~ ~ ~ ~b~ ~k ~ s~i~e exis~g sho~e 3'x47' of ~ ~ ~ is pm~ m ~ ~t~ ~ ~ ~ pl~ 3-1~'x38' ~on of · e ca~ p~lel W ~e e~t pwp~ ~e ~ pm~s~ ~ ~ ~ov~ ~ ~ ~ ~d on ~e w~t si~ of~e ~i~g f~ili~ ~j~t m ~e exi~g ~ bilk ~p - ~ov~ of p~fo~. · 1 m ~cc~d~nce with ~ defend s~iF~t~ns as IN WITNESS WH~R~, ~e seld ~ of Trust.s ~- by causes its Corporate. Seal to be afl?ed, and these presents to be subscr~ed by a 'malorlty of the se,d Board as of this darn. The perm~ee TERMS and GONDmONS Samuel & Anne DeLuca 1350 Glenn Road, Southold N. Y~ re~a~-g at part- o[ the ¢oedderafiou foe ~e for ~ ~ofl may ~ ~ m ~ ~ at a !.~; d~ o~ 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 May 28, 2003 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Dan Hall Land Use Ecological Services, Inc. 2576 Sound Avenue Baiting Hollow, NY 11933 SCTM#78-2-31 Samuel & Anne DeLuca 1350 Glenn Road Southold, NY Dear Mr. Hall: The Board of Town Trustees took the following action during a Regular Meeting, held on May 21, 2003 regarding the above matter WHEREAS, Land Use Ecological Services, Inc. on behalf of Samuel & Anne DeLuca applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated April 14, 2003 WHEREAS, said application was referred to the Southold Town Conservation Advisoxy Council for their findings and recommendations, and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on May 21, 2003 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. 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 SAMUEL & ANNE DELUCA request a Wetland Permit to ~constmct existing fixed timber dock and stabilize existing shoreline 3'x47' of fixed timber catwalk is proposed to be reconstructed in kind and place 3-1/2'x38' portion of the catwalk parallel to the east property line is proposed to be removed and reconstructed in kind on the west side of the existing facility adjacent to the existing concrete block ramp - removal of platform. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Depa~hnent 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. Inspections are required at a fee of $5.00 per inspection. (See attached schedule). FEES: $5.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC Albert J. Krupski, Pres/dent James King, Vice-President Artie Foster Ken Poliwo~a Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1566 BOARD OF TOWN TRUSTEES TOWN OF SOU'I~OLD 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. SAMUEL & ANNE DELUCA INSPECTION SCHEDULE .X __ Pm-construction, hay bale line · . 1st day of construction ½ constructed Project complete, compliance inspection. June g, 2003 Town of South~d Board of Tow~ Trustees P.O. Box 1179 SOuthold, N.Y. 11971 Attn: Al Krupski, President Re: Detuca Residence 1350 Glenn Rd. Southold, NY ShoceJlne Stabil~za~lo~ / Dock Reconstruction Dear Mr. Krupski: Enclosed p~ease rind the $5.00 inspection fee due in ,,,----~, - this off4.there are any questions ,,~ms to the above referenced Project. o~ if additional information i,~ ...... ""~'-'~ ~ do not hes/tate to contact $inceray, Land Use Ecological Services, Inc. DH Enc. F~Q. Box 1060. Village Dock.. Riverhead, New York. 11901 63 i'727-2400, FAX 63 !-727-2605 Albert J. Krup~ki, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53O95 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 SAMUEL & ANNE DE.L~JCA Please be advised that your app-xc~-tton, dated April 14. 2003 has been reviewed by this Beard, at the regular meeting of and the following action was taken: ( X ) 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: One Inspection @$5.00 TOTAL FEES DUE: $. 5.00 BY: E~~SIDENT, BOARD OF TRUSTEES Boam OF TRUSTr 4~98 Lan lUse May 22, 2003 Town of Southold Board of Town Trustees P.O. Box 1179 Southold, N.Y. 11971 27 Affn: Re: Al Krupski, President Deluca Residence 1350 Glenn Rd. Southotd, NY Shoreline Stabilization / Dock Reconstruction Dear Mr. Krupski: As per the trustees meeting held on May 21, 2003 enclosed please find (3) revised plans and project descriptions in regards to the above referenced project. These plans have been revised to eliminate the (2) platforms on the outside of the dock, and depict the widths of the dock to be corrected to reflect the measurements taken in the field by the trustees. Please do not hesitate to contact this office if there are any questions or if additional information i$ ~,ccded. Sincerely, Dan Hall Land Use Ecological Sen~ices, Inc. DH Enc. P.O. Box 1060. Village Dock, Riverhead, New York. 11901 631-727-2400 · FAX 631-727-2605 Field Inspection 5/14/03 Telephone (631) 765-1892 Town Hall. 53095 Ma. in Road P.O. Box 1179 Sour, hold. New York I19/1 SOITIHOLD TOWlq CONSEllYATION ADVISORY COUNCII, At the meeting of the Southold Town Conservation Advisory Council held Tuesday, May 13, 2003, the following recommendation was made: Moved by Don Wilder, seconded by Bill Cook, it was RESOLVED to recommend to the $outhold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of SAMUEL & ANNE DELUCA to reconstruct existing fixed timber dock and stabilize existing shoreline. 4'X 47' of fixed timber catwalk is proposed to be reconstructed in-kind and in-place. The 4'X 38' portion of the catwalk parallel to the east property line is proposed to be removed and reconstructed in-kind on the west side of the existing facility adjacent to the existing concrete block ramp. An area of eroded shoreline to the east of and adjacent to the existing boat ramp (50 sf.) is proposed to be augmented with 10+/- cy. of clean fill from an approved upland soume and planted with Spartina Alterniflora on 18" centers. A 67+/- linear ff. of 20-50 lb. stone is proposed to be placed by hand along eroded scarp and fill area and along cut bulkhead to the east of the ramp. 11+/- If. Of one row and one block high precast concrete block wall is proposed on the west side of the ramp landward of the existing cut bulkhead. Located: 1350 Glenn Rd., Southold. SCTM#78-2-31 The CAC recommends Approval with the Condition that all areas, except the boat ramp, be re-vegetated with natural plantings. Vote of Council: Ayes: All Motion Carried LandUse April 11, 2003 Town of Southold Board of Town Trustees P.O. Box 1179 Southold, N.Y. 11971 ~ Re: DeLuca, Glenn Rd. Southold Proposed Dock Reconstruction, Shoreline Stabilization To whom it may concern: South01d ~'0wn Board of Trustees Enclosed please find an application packa9® which includes the follo~ng: - (1) original, (2) copies of the completed application form. - (1) original, (2) copies of a Short Environmental Assessment Form - (3) sets of Plans. - Application fee ($200.00). APR 14 ? If there are any questions, or if you require additional information please don't hesitate to contact this office. Sincerely, Land Use Ecological Services, Inc. DH Eric. 2576 Sound A',,'enue · Baiting Hollow, Ne,,,',,' York · 11933 631 727-2400 · FAX 631-727-2605 ..dUN SITE_.,': N PLAN VIEW SCALE: 1" = 30' APl BY OAR "w?¥'N 'HOLD C~.~ 3.£'x $~' FtXEDTIMBER ~ AU( TO ~ CON~'FRUCTED Pt. ES \ f UTILIZING 4' X 4 CCA TB/BER DOCK ~,~ JSUFFOLK COUNTY HAGSTROM MAP # 29 SCALE: 1' = 3,000' +t- DATUM: TIDAL RANGE: 2.0 '~/_ PROPOSED 67LINEAR FT. 'el- (1.5 CUBIC YDS. +1-) OF 20- !~0 LB. STONE TO BE PLACED BY ~O ALONG TOE OF EXISTING ERODED 8CJ~P AND ALONG CUT BULKHEAD TO ALWM. = 50 SQ. FT. +/- PROPOSED TO BE A~ED WITH 10 +/- CUBIC YDS. OF CLEAN FILL FROM AN APPROVED UPLAND ~OURCE, AND TO BE PLANTED WITH Spartina altemttkxa (Z' PEAT POTS) ON 18" CENTERS /.6 LANDWARD LNIT OF TION. WETLANDS AS DELINEATED BY C. W. BOWMAN OF INC. ON 1-O9-O3. 4 APPROX 20Cf +1- PROPOSED ~ 'X 47' (TOTAL LINEAR FT) FIXED TIdBER CATWALK'TO BE RECONSTRUCTED IN KtND AND PLACE UTILIZING 4" X 4" CCA TIMBER DOCK PILES EBB-~'~'~-~F'LO00 SHEET 1 OF 2 Deluca - Southold JUN 3 2003 ,Southold Town Board of Trustees Project Descrlpt on: (5-22-03) Applicant proposes to reconstruct existing fixed timber dock and stabilize existing shoreline. 3' x 47' of fixed timber catwalk is proposed to be reconstructed in kind and place. The 3.5' x 38' portion of the catwalk parallel to the east property line is proposed to be removed and reconstructed in kind on the west side of the existing facility adjacent to the existing concrete block ra~rea of eroded shoreline to the east of and adjacent to the existing boat ramp (50+/- s.f.) is proposed to be augmented with 10+/- cubic yards of clean fill fi~om an approved upland source and planted with ~ altemitlora (2" peat pots) on 18" centers. A proposed 6?+/- linear feet (l.5+/- cubic yards) of 20-501b. stone is proposed to be placed by hand along existing eroded scarp and proposed fill area and along cut bulkhead to the east of the ramp. 1 l+/- linear feet of one row and one block high precast concrete block wall is proposed on the west side of the ramp landward of the existing cut bulkhead. DEPARTMENT OF THE ARMY NEW YORK DISTRICT, CORPS OF ENGINEERS JACOB K. JAVITS FEDERAL BUILDING NEVV YORK, N.Y. 10278-0090 REPLY TO ATTENTION OF Eastern Permits Section June 12, 2003 SUBJECT: Application No. 2003-00330-L2 by Samuel and Ann DeLuca To Whom It May Concern: The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: i' CEI 'E 3306 2ooa pier. U twl~.e Permit Program :ina 4~ ~6~.fixed t APPLICANT: Samuel and Ann DeLuca 1350 Glenn Road Southold, New York 11 ACTIVITY: Install a 4' X 38' fix authority of the Natic 1) reconstruct an exis ~ber pier secured by 28 pil area of eroded shoreline, adjacent to an existing boat ramp, with 67 linear'feet (approximately 1.5 cubic yards) of 20-50 pounds of stone to be place by hand along the toe of an existing, eroded scarp and along a bulkhead cut to ALW, 3) discharge approximately 10 cubic yards of fill into a 50 square foot area of eroded shoreline and plant Spartina alterniflora in 2" peat pots on 18" centers, and 4) install an 11 linear foot (1 row and 1 block high) precast concrete block wall on the west side of the ramp landward of the cut bulkhead. The project purposes are erosion prevention and a safe mooring facility. WATERWAY: West Creek, Southold Bay, Shelter Island Sound LOCATION: Town of Southold, Suffolk County, New York As this is minor in nature, authorization may be by Letter of Permission. This is in accordance with current Federal Regulations governing work in navigable waters of the United States. To accomplish the coordination required, prior to the issuance of a Letter of Permission, your review of the enclosed drawings is requested. Pursuant to Section 307 (c)' of the Coastal Zone Management Act of 1972 as amended (16 U.S.C. 1465 (c) (3) (A)), the applicant has certified that the activity complies with and will be conducted in a manner that is consistent with the approved state coastal zone management program. To allow for the timely processing of the subject application, your comments are requested within 15 days of date of this letter. the Enclosure Sincerely, Dr. Marc Helman Acting Chief Eastern Permits Section 2 GLENN RO4D -- C N PLAN VIEW SCALE: 1" = 30' SUFFOLK COUNTY HAGSTROM MAP # 29 SCALE: 1' = 3,000~ +t- DATUM: TIDAL RANGE: 2.0 '~/_ ~ = PROPO.SED 67LINEAR FT. +1- (?.5 CUBIC YDS..+1-) OF 2~ 50 LB. STONE TO BE PLACED BY HAND '~t ~ ALONG TOE OF EXISTING ERODED SCARP Spar~ina atlemJt~ (2' PEAT POTS) ON ir CENTERS PROPOSED 4' X 38' FIXED TIMBERTED '~/ ' GAT~NAi. K TO .1~. CONSTRUC ~ piLES ~ /~ \ ~ ~ 8 J ~ f .~ / \ ~ ' LANDWARD L~Irr OF TIDAL WETLANDS ~ / ~ ~ ~ ~ _ AS DELINEATED BY C. W. BOWMM4 OF ~, a. LAND USE ECOLOGICAL SERVICES INC. ' / \ ~:. ~:~-- ~ ~g'~ ~ EXlSTINGCAT~NALKTOBEREMOVED ' PROP. CONCRETE WALL ' ; ' LANDU== I ~--~ ~o~L~ k~ ~ ~ ~-/~ .... .'~ PROPOSE04'X4T(TOTALLINEARFT) FIXEDT~MBER B~OLO~I¢~4. - . CATWALK TO BE RECONSTRUCTED IN KIND AND PLAC · ,,~,.,:,~...~.--~ I ~'~'-~/ z~ -RWEST CREEK ~'~-.~ I WIDTH O~WA'/~/~WAY ~~' ANEET I OF Albert J. Krupski, President James I~Ling, Vice-President Henry Smith Attic Foster Ken Poliwoda Town Hall 63095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only .~wOaStal Erosion Permit Application etland Permit Application Major .Waiver/Amendmept/Chapges Received Application: ~! tq lO b Received Fee:$ ~/t~'-'", t , , .Completed AppliCafion o~ Iq'. 6 ~ Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date g/m.t),__.~_ 'CAC Referral Sent: d-llt..t ] 03 Date of Inspection: ~'~Jtd/, '[ 0 ~ Receipt of CAC Report ~ ' Lead Agency Determination:__ Technical Review: Public Hearing Held: ~"~f~,-I [O "~ Resolution: "' ! Minor Southnld Town Joard of Trustees Name of Applicant Samuel & Anne Deluca 1350 Glenn Rd. Southold, NY 11971-3306 Address Phone Number:( ) (631) 765-9390 Suffolk County Tax Map Number: 1000--78-2-31 Property Location: 1350 Glenn Rd. Southold, NY 11 )71-3306 (provide LILCO Pole #, distance to cross streets, and location) AGENT: Dan Hall / Land Use Ecological Services, Inc. (If applicable) Address: 2576 Sound Ave. Baiting Hollow NY 11933 Phone: (631) 727-2400 Board of Trustees Application Land Area (in ~uare f~t): Area Zoning: Residential GENERAL DATA .5 . Residential Previousu~ otprope~y:. Residential Intended useofpropeny: Pfiorpermit~approvalsfor siteimprovements: Agency Date Southold Trustees Permit 5050 8-30-99 NYSDEC (NOV) 7-29-99 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Project Description (use attachments if necessary): Se~otd 1~. Board of Trustees Please see attached project description. klbert J. Krupsld, Presiden/"~ James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall .53095 Route 25 P.O. Box 1179 Southokl, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application STATE OF NEW YORK) AFFIDAVIT OF POSTING I Z~ ~ ~ .residing at b~ng du~y sworn, depoae and s~: T~at on the~~ da~ of~ ~ 200~, I personally posted the property known as ~6~ ~/~. /~0 by placing the Board of Trustees official poster where ft 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~e ~ubltc hearing~Date of hear~g _noted thereon to be held~ Dated: ublic / NCYNTHIA ALVAREZ - OTAR¥ PUBLIC, ~TATE OF NEW YORK No. 01AL6080878 QUAUFIED IN SUFFOLK COUN~¢ COMMISSION EXPIRES SEPt. 23, 200~ Deluca- Southold Project Description: (4-11-03 ) Applicant proposes to reconstruct existing fixed timber dock and stabilize existing shoreline. 4' x 47' of~fixed timber catwalk is proposed to be reconstructed in kind and place. The 4' x 38' portion of the catwalk parallel to the east property line is proposed to be removed and reconstructed in kind on the west side of the existing facility adjacent to the existing concrete block ramp. An area of eroded shoreline to the east of and adjacent to the existing boat ramp (50+/- s.f.) is proposed to be augmented with 10+/- cubic yards of, clean fill t~om an approved upland source and planted with Spartina altemiflora (2" peat pots) on 18" centers. A proposed 67+/- linear feet (1.5+/- cubic yards) of 20-501b. stone is proposed to be placed by hand along existing eroded scarp and proposed fill area and along cut bulkhead to the east of the ramp. 1 I+/- linear feet of one row and one block high precast concrete block wall is proposed on the west side of the ramp landward of the existing cut bulkhead. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpe~ oftheproposed operations: Recreational Mooring Shoreline Stabilization. Area of wetlands on lot: 2,4 7 0 +/- square feet Percent coverage of lot: 1 1 +/- % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 0 feet Does the project involve 'excavation or filling? X No Yes If yes, how much material will be excavated? 0 cubic yards How much material will be filled? 1 + / - cubic yards Depth of which material will be removed or deposited: 0 Proposed slope throughout the area of operations: N/A feet Manner in which material will be removed or deposited: BY Hand ~ ~ C E I ~ ~-~ ~ APll 14 lira $oulluld Town Boord ~ Trust]es 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): Proposed project will not have any negative effect upon the adjacent tidal wetlands. Board of Trustees Application COASTAL EROSION APPLICATION DATA Recreational Mooring, Purposes of proposed activity: and Shoreline Stabilization. Are wetlands present within lO0 feet of the proposed activity? x No Yes Does the project involve excavation or filling? No x Yes If Yes, how much material will be excavated? 0 How much material will be filled? 1 + / - Manner in which materi~il will be removed or deposited: ' (cubic yards) (cubic yards) by hand Describe the nature and extent oftbe environmental impacts reasonably anticipated resulting from implementation oftbe project as proposed. (Use attachments if necessary) The proposed project will not have any negative effect upon the adjacent tidal wetlands. The shoreline stabilization may have a beneficial impact on the adjacent tidal wetlands. Board of Trustees Application County of SufFolk State of New York Dan Hall / Land Ecological Services, InBEINGDULYSWORN 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 AG]RIq. P.S TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER ORBY VIRTUE OF SAID PERMIT(S), IY 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 CONKONCTION WITH REVIEW OF THIS APPLICATIOn. ~../r Signature ' SWORN' TO BEFORE ME THIS DAY OF Noto, fy Public CYNTHIA ALVAREZ N0?AR¥ PUBLIC, STALE 0F N~V yORK No. 01AL6080878 ~AU~EO ~ SUF~OL~ court, COMMISSION EXPIRES SEPI 23, of Trustees Applicatio~ Ab'£nORIZATiON (where the applicant is not the owner) Samuel & Anne DeLuca I, (print owner of property) Southold, NY Ecological Services, Inc. residing at 1350 Glenn Rd. (mailing address) do hereby authorize Land Use (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. signature ) APR ,1 4 20O3 Southold Town Board of Trustees STATE ENVIRONMENTAL ALI VIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNUSTED ACTIONS Only · 1 - PROJECT INF 1. APPLICANT / SPONSOR 2. PROJECT NAME D Hall/Land Use for Samuel Deluca Detuca - Southold 3.PROJECT LOCATION: Southotd Suffolk Municipality Courtly 4. PRECISE LOCATION: Street Addess and Road Intemecfl(~s, Promlnan{ landmarks utc -or provide map 1350 Glenn Rd. So(Jlhold, NY sC'rM# 1000-78-2-31 5. IS PROPOSED ACTION: [] New [] Expansion [] Modl6ca~xl/alleration 6, DESCRIBE PROJECT BRIEFLY: '. AMOUNT OF LANO AFFECTED: i ~,n"~/ .5+1- ~ umme~/ .5+1- .. W.LL PROPOSe. *CT . COM V ZOR,N OR OT.ER 9. WHAT I$ PRES~NI' LAND USE IN vlclNrrY OF PROJECT? (Choo~easmanylll~.) 10. DOES ACTION INVOLVE A PERMIT APIN~OVAL, OR FUNDING, NOW OR ULTIMA'I~LY PROM NMY OTHER GOVERNMENTN. USAC~3E, NY~:~3$, & ~ If yes, ll~ agency name and permit I ilpf~ovllh 12. AS A I~ULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE M( D~FI~ nON? I CERTIFY THAT 11-1E INFORMATION PROVIDED ABOVE IS TRUE TO THE BES OF MY KN~JLtkt~wn [q~T Trustees ~ App,cm.t / Spon~ Nam~ nan H llklLand. U~e Ecological Services, Inc. 0ate: i~arch 4, 2003 1 If the action is a Costal Area, and you am a state agency, complete the Coastal Assessment Form before proceeding with this assessment