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Home My WebLink AboutTR-5663Albert 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 1, 2003 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Dan Hall Land Use Ecological Services, Inc. 2576 Sound Ave. Baiting Hollow, NY 11933 CANDACE M. CORLETT 300 CLEARVIEW RD., SOUTHOLD SCTM#90-4-8.2 Dear Mr. Hall: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 30, 2003: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #5663 to reduce the width of the 4'X 66.5' catwalk to 3'X 66.5'. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krups/ki, Jr. * President, Board of Trustees AJK:lms Albert J. Krupsld, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application, dated ~/l~/O~ has been reviewed by this Board, at the regular meeting of ~/~O/O3 and the following action was taken: ( /Application Approved (__) Application Denied (__) Application Tabled (see below) (see below) (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: ra qo ---ClOt. Ob FEES UE.. PRESIDENT, BOARD OF TRUSTEES BY: ~EN~, BOARD OF TRUSTEES 4/98 Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda PegKg A. Dickerson Town Hail 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 May 1, 2003 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Mr. Dan Hall Land Use Ecological Services, Inc. 2576 Sound Ave. Baiting Hollow, NY 11933 CANDACE M. CORLETT 300 CLEARVIEW RD., SOUTHOLD SCTM#90-4-8.2 Dear Mr. Hall: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 30, 2003: RESOLVED, that the Southold Toxvn Board of Trustees APPROVE the Amendment to Permit #5663 to reduce the width of the 4'X 66.5' catwalk to 3'X 66.5'. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupsgki, Jr. President, Board o f Trustees AJK:lms (631) 765-1892 Town H',dl. 53095 M~in ~ P.O. Box 1179 Southokl, New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Wednesday, April 16, 2003, the following recommendation was made: Moved by Bob Ghosio, seconded by William Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Amendment Request of CANDACE M. CORLETT to Amend Permit #5663 to reduce the width of the 4'X 66.5' catwalk to 3' X 66.5'. Located: 300 Clearview Rd., Southold. SCTM#90-4-8.2 Vote of Council: Ayes: All Motion Carried Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. d~. ~1~ ~Jlt DATE: ...~.~v. 20~kL 2002 ISSUED TO .... CANDANCE M'.~ CORLET? .................... XuI'h rization Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 40~ of the Laws of the State of New York 1952; and the Southold Town Ordinance 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;.'L and in accordance with the Resolution of The B6ard adopted afa meefincj held on .....~.~ 20.~.~....., and in consideration of the sum of $. Z00..o0 ..... peld by -Land Use'"'Ecologte~I' on" l~ehalf 6f 'C'indi~'k'~'"'~'~'"?~:{"~"' of ........ ~?:i:~g ..~l~ll~v ............... N. Y. and SUblet fo the Te~s end ~onditions lided on the reve~ slde he--f, of Southold Town TrusSes authorizes and ~rm~ ~ fo~wlng: IN WITNESS WHEREOF, ~e said ~rd ot Ims~ees ~- by causes ifs ~or~rate Seal to be e~ixed, and ~ese ~[e~n~ be sub~ribed by a metal~ of t~ se~d ~erd as of thts date. The Pelmittee TERMS and CONDmONS Gandan~ M Corlett ~ ..... ~ .... ,~__ · o , lq. ¥~ · t 300 C .............. , ~,~,tth~ld, the comidemfioa fo~ the immnce of the 1~;~,~.'-~ d6es uaclemsad ami ptesctt~ to the 24 2. That thls Permk is' valld fo~ ~ peclod o~ . mm. wbkh h comideted to be the for an ,-,-t~ion may be made to the Boezd at a late~ ds__~_ ~. That ~ Permit ~ould be re~ined indefinitely, or as long as the to maintain the mmcta~ ot project involved, to provide evic~ce to anyone omcemed that auth- ofizatlo~ was originally ,~. That d~e work involved witl be mbject to the impectioa and apl~OVal of the Board o~ ia ageau, and non-compt~a~e with the provisions of the otlg~atiag apl, li~tion, may be ~.~ for t*evoc~tio~ of this P~m~t by ~e~lutlma of I~e ~ab] Boa~ 5. That ti~ere will be no ~le intexfe~e~ce wida mvig~o~ *s · ~suk of the wo~ 6. That d~ere shall be ~o interfere~e sdlh the right of the pul~c eo pass ~d t~ss ~a~g the be~ch betwee~ high and low wacex maxks. 7. That if future Ol~atiom of the Town of 8outhold ~ the mnoval ~l/ac demutem lnthe locatiosa of thc work hexeln ~ or If, in the oplnkm of the lto~d o~ Tnm~ the work shall cause utueasombte obsuucuo~ to f~ee uavigadoa, the said Pmnlttee will be teqult~ upon due noOce, to remove or alter this work o~ project hex-eha sueed sdthout ezl, emes to the Town 8. That the said Board will be notified by the Pesmlttee ot d~ complg~km Of the vro~k ~ orlzed. 9. That the Petmlttee will obtain ,!1 o~het permlt~ and cameaU d~t m~y be required plemental to chis pet'mit whid~ may be mbject to ~-evoke upon fdl,,~ to obtain r4aae. 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 December 11, 2002 Mr. Dan Hall Land Use Ecological Services, Inc. 2576 Sound Avenue Baiting Holloxv, NY 11933 RE: SCTM# 90-4-8.2 Candace M. Corlett 300 Clearviexv Road Southold, NY Dear Mr. Hall: The Board of Town Trustees took the following action during a Regular Meeting, held on November 20th, 2002 regarding the above matter. WHEREAS, Land Use Ecological Services, Inc.. On behalf of Candace M. Corlett applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated October 3rd 2002 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Hearing xvas held by the Town Trustees with respect to said application on November 20th 2002 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, 2 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 Candace M. Corlett Wetland Permit to construct a dock facility consisting of the following 4'x 66.5' fixed timber catwalk, 3'x12' ramp, and 6'x20' float catwalk is proposed to be elevated a minimum of above the existing grade (10) 4"x4" timber piles are proposed to support the fixed dock landward of the AHWM and (8) 6" Dia. Timber piles are proposed to support the dock seaward of the AHWM (2) 6" Dia. Timber piles are proposed to support the float. End of the fix catwalk ends no greater than four feet fi.om the edge of marsh - add ramp and float - no need to be four feet above marsh with handrails - down to about 2-1/2 feet- subject to new plans include marsh fringe in plans does not include hand rails - keep it loxv profile as the neighboring docks all pilings cut off near deck of grade. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of $5.00 per inspection (See attached schedule). FEES: None Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC LanclUse January 8, 2003 Town of Southold Board of Town Trustees P.O. Box 1179 Southold, N.Y. 11971 Attn: Al Krupski, President Re: Corlett - Southold 300 Clear View Rd. Proposed Dock JAN _ 9 Dear Mr. Krupski: Enclosed please find (3) sets of plans and project descriptions in regards to the above referenced project. These plans have been revised as per the comments of the trustees meeting held on November 20, 2002. Please do not hesitate to contact this office if there are any questions or if additional information is needed. ~~Sincerely' Dan Hall Land Use Ecological Services. Inc. DH Enc. 2~,7u Sound Avenue · Baiting Hollo,.,,. Ne','., ¥?rk 1 lv~.a 631 727-2400· F.~3<' ~.,~":1,7~ ~ ~"~ c,,',-z.,~ ~,~_. Telephone (631) 765-1892 Town H',dl. 53095 Main Road P.O. Box 1179 Sou~.hotd, New York 11971 SOUTHOLD TO'~FN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, November 18, 2002, the following recommendation was made: CANDACE M. CORLETT to construct a dock facility consisting of a 4'X 79.5' fixed timber catwalk, 3'X 12' ramp, and 6'X 20' float. The catwalk is proposed to be elevated a min. of 4' above the existing grade. (10) 4"X 4" timber piles are proposed to support the fixed dock landward of the AHWM and (8) 6" diameter timber piles to support the dock seaward of the AHWM. (2) 6" dia. timber piles are proposed to support the float. Located: 300 Clearview Rd., Southold. SCTM#90-4-8.2 The CAC did not make an inspection, therefore no recommendation was made. REPLY TO ATTEN~qON OF: Eastern Permits Section DEPARTMENT OF THE ARMY NEVV YORK DISTRICT, CORPS OF ENGINEERS JACOE~ K. JAVlTS FEDERAL BUILDING NEW YORK, N.Y. 10278-0090 January 23, 2003 SUBJECT: Application Number 2002-01319-L2 by Ca ,JA[4 2 ,' 200~ SoLJthhold T~wn .dace M. B~c~rt~Iees The New York District, U.S. Army Corps of Engineers, has received a request for Department of the Army authorization for the following activity: APPLICANT: Candace M. Corlett 84-35 Kendrick Place Jamaica Estates, NY 11432 ACTIVITY: Install a 4' X 66.5' fixed timber pier, 3' X 12' ramp (seasonal), and a 6' X 20' float secured by two (2) guide piles(seasonal). The pier will be a minimum of 2.5' above the grade or tidal wetlands. The pier will be supported by 4" X 4" timber piles landward of mean high water and 6" diameter piles seaward of mean high water. The purpose of this project is to the applicant with safe recreational mooring. WATERWAY: Sandpiper Basin, Shelter Island Sound LOCATION: Cedar Beach, 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 the date of this letter. Sincerely, Dr. Marc Helman Acting Chief Eastern Permits Section Enclosure 0 m SANDPIPER BASIN / / '" . oO~*° SANDPIPER BASIN ,0 (oz-) ~ ooO° Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095MainRoad P.O. Box 1179 Southold, New York 11971 Telephone(516) 765-1892 Fax(516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD LETTER OF REQUEST FOR AN AMENDMENT DATE 3/13/03 0WNERCandace M. Corlett PHONE (212) 924-7780 · ADDi~SS 84~35 Kendrick Place, Jamaica Estates, NY 11432 Dan Hall/Land Use AGENTEcological Svcs, Inc. PHONE (631 ) 727-2400 ADDRESS 2576 Sound Avenue, Baiting Hollow, NY 11933 PROPERTYLOCATION 300 Clearview Rd., Southold, NY 11971 TAX MAPNO. 1000-90-4-8.2 ~V¢ the owner & aqent request ~Amendmentt0Pcmfit# reducing the width of the 4'X66.5' catwalk to 3' x 66.5' as per NYSDEC. 5663 Signed By: [ ~)//~4",/' ' ' Corlett - Southold Project Description: (2-27-03) Applicant proposes to construct a dock facility consisting of the following: 3' x 66.5' fixed timber catwalk, 3' x 12' ramp (seasonal), and 6' x 20' float (seasonal). The catwalk is proposed to be elevated a minimum of 2.5' above the existing grade. (12) 4" x 4" timber piles are proposed to support the fixed dock landward of the AHWM and (6) 6" Dia. timber piles are proposed to support the dock seaward of the AHWM. (2) 6" Dia. timber piles are proposed to support the float. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Joseph Monaco Jr. Robert & Gurly Maus Address: 595 Oakwood Ct. PO Box 742 Southold NY 11971 450 Clearview Rd. Southol& NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK , residing at 2_&'Dq ~cx~..& ]k~ , being duly sworn, deposes and says that on the ,200g, deponent mailed a tree copy of the Notice [ (~'-n. - dayof set forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll 0fthe Town of Southold; that said Notices were mailed at the United States,Post Office at ~__o,[Ve.~{-o--, /,,1 (certified) (registered) mail. --' CYNTHIA ALVAREZ ,"iOIARY PUflLIC, STALE OF NEW YOflK No. 01AL6080878 QUALIFIED IN SOFFOLK COUNTY 2s, 20o_ ] Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall .53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, ~~. ~3j~), residing at ~-~ ~F~n~ being duly ~worn, dapose an~ say: That on the /~ ~ ' day~f~f~, 20p~, I personally posted__ --the known property as ~OC~ ffFo~ by placing the Board of Tr6s~ees/of~icial pos'ter where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public h~aring. Date of hearing noted thereon to be Dated: (signature) Sworn to before me this of - 20 CYNT~ NOTARY PUBLIC, STAT5 OF Nk'W'~RK ~ No. 01AL6080878 ~ QUAUFIED IN SUFFOLK COUNt( [ MYCOMMISSION EXPIRES SEPT, 23,20~ ] LandUse March 14, 2003 Town of Southold Board of Town Trustees P.O. Box 1179 Southold, N.Y. 11971 Attn: Al Krupski, President Re: Corlett - Southold 300 Clear View Rd. Proposed Dock Permit #5663 Amendment Request Dear Mr. Krupski: Enclosed please find an amendment request for the above referenced permit reducing the width of the proposed catwalk from 4' to 3' which includes the following: - (1) original, (2) copies of a Letter Of Request For An Amendment. - $40.00 fee. - (3) revised plans. - (3) Revised Project Descriptions. Please do not hesitate to contact this office if there are any questions or if additinnal information is DH Enc. Land Use Ecological Set Albert J. Krupski, President James King, Vice-President Henry Smith Attic Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _C~gastal Erosion Permit Application --.~etland Permit Application ~'Major Waiver/Amendment/Changes ,~ Received Application: IO1510 . ~Keceived Fee:$ ,~30e . ,,"'Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted__ Coordination:(date sent) .~AC Referral Sent: ~.~~ ~.Date of Inspection:~ Receipt of CAC Report: · Lead Agency Determination: Technical Review: · -'"Public Hearing Held: I[[i}.~[{~-~ Resolution: Minor 8L;I - 3 TM !¢ Name of Applicant Candace M. Corlett Address 84-35 Kendrick Place Jamaica Estates, NY 11432 Phone Number:( ) 212-924-7780 Suffolk County Tax Map Number: 1000 - 90-4-8.2 Property Location: 300 Clearview Road Southold, NY Northeast corner of Clearview Road and Doqwood Drive (provide LILCO Pole #, distance to cross streets, and location) AGENT: Dan Hall/Land Use Ecological Services, Inc. (If applicable) Address: 2576 Sound Avenue Baiting Hollow, NY 11933 Phone: 631-727-2400 Board of Trustees Application GENERAL DATA Land Area (in square feet):. 28,793.49 s.f. Area Zoning: Residential Previous use of property:. Residential Residential Intended use of property:. Prior permits/approvals for site improvements: Agency Date None Known X __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes, provide explanation: Proj ect Description (use attachments if necessary):. Please see attached project descriotion. Corlett - Southold Project Description: Applicant proposes to construct a dock facility consisting of the following: 4' x 79.5' fixed timber catwalk, 3' x 12' ramp, and 6' x 20' float. The catwalk is proposed to be elevated a minimum of 4' above the existing grade. (10) 4" x 4" timber piles are proposed to support the fixed dock landward of the ^HWM and (8) 6" Dia. timber piles are proposed to support the dock seaward of the ^HWM. (2) 6" Dia. timber piles are proposed to support the float. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICAT/ON DATA Purpose of the proposed operations: Recreational Dock Area of wetlands on lot: 1,450 +/- square feet Percent coverage of lot: 3.6 +/- % Closest distance between nearest existing structure and upland edge of wetlands: 90 +/- 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? n/a cubic yards How much nmterial will be filled? n/a cubic yards Depth of which material will be removed or deposited: n/a feet Proposed slope throughout the area of operations: n/a Manner in which material will be removed or deposited: n/a 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): This project will not have any negative affect on the adjac ~ent wetland areas. Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Recreational Dock Are wetlands present within 100 feet of the proposed activity? No X Yes Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? n/a How much material will be filled? n/a Manner in which material will be removed or deposited: (cubic yards) (cubic yards) n/a Describe the nature and ex-tent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Proposed project will not have any negative affect on the adjacent wetland areas. Albert J. lea-upski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall .53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631 ) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I , Dan Hall , residing at 4 Hiqhvi~_w In: Ridge, NY 11961 being duly sworn, depose and say: That on the -~ day of ~O~. , 200~ I personally posted the property known as_~c~5~w__Rd ...... by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date o~_~t~e ~ublic hearing. Date of hearing noted thereon to be held /~/.. Dated: Sworn to before me this blic CYNTHIA ALVARF. Z NOTARY PUBLIC. STATE OF NEW YORK No. 01AL6080878 Board of Trustees Application County of Suffolk State of New York Dan Hall/Land Use Ecological Services, Inc. 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 SOLrI~OLD 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. SWORN TO BEFORE ME THIS ~ DAY OFt/'~~ ,20 U> ~r' Tanya Lachenmeyer NOTARY PUBLIC, State of New Yol~ No. 01LA5032219, Suffolk County Commission Expires, August 22, 20...~,(-. FAX 6.'11 ?2?2605 LIND USE £COLO;IC%L of TrUStees. Appl/~ation AUTHOP~ ZA~ION (where the applicant is not the owner) ~print owner of Dro~erty) residing at (mailin~ Ecological Services, Inc. ~and Use 40 ~ereby authorize (Agent} .to apply for pamit(s) from the Southuld Board of ~ Trustees on ~y behalf. ,'(Owner,s si~ature)~ 8 PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR D Hall/Land Use for Candace M. Codett 3,PROJECT LOCATION: Southold Municipali[y 617~0 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by ,a ~icant or Project Sponsor) 2. PROJECT NAME Codett - Southold Suffolk PRECISE LOCATION: Street Addess and Road [ntemectlons, Prominent landmarks etc -or provide map 300 Clearview Rd. Southold, NY 11971 SCTM# 1000-90-4-8.2 5. IS PROPOSED ACTION: [] New pensian [] Modifiseflan / alteration SEQR 6. DESCRIBE pROJECT BRIEFLY: Please See Attached Project Description. 7'. AMOUNT OF LAND A~FECTED: " ~nitially .89+/- acres Ultimata~y .89+/- acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [] yes [] No ff no, d.cdbe brfefly; 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~ Other (desc~be) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) []Yes [~No E yes, list agency name--a~d permit / approval: USACOE, NYSDOS, & SOUTHOLD TOWN 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVed.? E~Yes [-~No If yes, list agency name and permit / approval: A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant ,J..~Sponsor Name Dan H{all/~ar{d Use E.e/ol,~g'!~l Services. Inc. Date: September 26, 200; ./ / / [ If the action Is a Costal Area, and you am a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART Il - iMPACT ASSESSMENT (To be completed by Lead A~lency) A. DOES ACTION EXCEED ANY TYPE ~ THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review proce~e end u~e the FULl. FAF. declaration may be ~uporseded by amYJ~r involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (N~swers may be handwritten, if legible) C1. Exi~ng air quality, sumacs or groundwater quality m quantity, ndce levels, mdsting trafllc pottem, solid waste pmductk~ or disl3osal, poten~al for erosion, ,dr~nage or florx~n~ problems? , ~F~atn ~,, , ,, C2. Aesthetic, agrlcelbx~, arc~icel, historic, or ~hor na~,rai or cultural reecornas; or cemmunify or naighbedlood charactor? Explain briny: C3. !agetatfon or fauna, fish, sbeifl!Sh or wtidl'i~e apedes, slg~'l~lcont habitat, or threatened or endaagemd sbec~es? Explain I~.-,ify: ' ' ' I E. IS THERE OR IS THERE LIKELY TO BE CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ff,/es e~plaln: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reach~dvemee~e~t~den~edab~ve~determinawhe~horitissbt~stan§a~arge~important~r~therwisesigni~c~nt~ Each effect should be assessed In connection with its (a) setting (i.e. urban or rural): (b) pmbabitity of occon~g; (c) dumifon; (d) irreversibili~ (e) geographic scope; and (t~ magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient dofaH th chow that aH rstevant adverse impacts have been Irish§fled and adequately addresS. If question d of part ii was checked yes, the determination of sigr tirma nce mu st evaluate the potential impact of the proposed action o~ the environmental characteristic~ of the CEA, Check this hex if ~u have Iden~fled one or mare pofentially large or aigntiicant adveme Impacts ~hich MAY occur. Then proceed directiy to the F U!..[ FAF and/or prepare · positive dedaratias. Check this bex ff ~ have determined, based ce If~ Infon'na¢~ end analysis above end any ~uppo~Jng documentation, that the preposed actior ~flLL NOT result in any stgnifmant adverse en¥1ronmentsl impacts AND provide, on attachmer,/s as ce~assa~y, the reasons supperting thi.. Name nt Lasd Agency Date Title of Responsible Officer Print or T~e'~lame of Responsible Office- in Lead Agency Signature of Resp(msible Officer in Lead Agency S~:Jnatum of Preparer (ff different from responsible officer)