HomeMy WebLinkAboutTR-5266
QF soar Town Hall Annex
John Bredemeyer, President
Michael J. Domino, Vice Pres. 54375 Main Road
P.O. Box 1179
James F. King 1~t # Southold, New York 11971-0959
Charles J. Sanders fn ac
G • ~O Telephone (631) 765-1892
O~~,COU'~ Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0945C Date: January 7, 2014
THIS CERTIFIES that the construction of addition to existing single-family dwelling;
installation of gutters, leaders and drvwells, disturbed area re-vegetated
At 250 Pine Tree Court- Cutchogue, New York
Suffolk County Tax Map # 98-1-7.11
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated January 3, 2001 pursuant to which Trustees Wetland Permit #5266 Dated
January 24, 2001, was issued and Amended on April 25, 2002 and conforms to all of the
requirements and conditions of the
applicable provisions of law. The project for which this certificate is being issued is
for the construction of addition to existing single-family dwelling; installation of gutters,
leaders and drvwells, disturbed area re-vegetated.
The certificate is issued to JOSEPH GULMI & SUSAN BRAVER owners of the
aforesaid property.
v ~
Authori a Signatur
• 0
James F. King, President O~OgUfF04e Town Hall, 53095 Main Rd.
Bob Ghosio, Jr., Vice-President ~y Gy P.O. Box 1179
Dave Bergen H Southold, NY 11971
JohnBredemeyer O Telephone(631)765-1892
Michael J. Domino Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
DATE F INSPECTION: C. - / / 3
Ch. 275 Ch. 111
INSPECTION SCHEDULE
- Pre-construction, hay bale line/silt boom/silt curtain
- tat day of construction
%2 constructed
Project complete, compliance inspection.
INSPECTED BY: J, )e,/ X)J
COMMENTS:
v arf J°-f tf u-,~~DvzT /n p/lY t~ l/ S
s¢s i2 ~f~.1-c ~'r 5'a ~ a i/a Y Zoo t
CERTIFICATE OF COMPLIANCE: 1
Albert J. Krupaki, President Town Hall
James King, Vice-President ~~gtJFFO(,~c 53095 Route 25
Artie Foster P.O. Box 1179
Ken Poliwoda O Southold, New York 11971-0959
Peggy A. Dickerson N Z
v, Telephone(631)765-1892
Fax (631) 765-1366
y~ol ~ ~ao~
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
April 25, 2002
Mr. Joseph Gulmi
Ms. Susan Braver
250 Pine Street
Cutchogue, NY" 11935
RE: 250 Pine Tree Court, Cutchogue
SCTM#98-1-7.11
Dear Mr. Gulmi & Ms. Braver:
The following action was taken by the Southold Town Board of Trustees at their Regular
Meeting held on Wednesday, April 24, 2002:
RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit
#5266 for a 2' extension to the previously permitted house addition.
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. Krupski, Jr.
President, Board of Trustees
AJK:ims
Q~~S~FfQGf-coG
c Town Hall. 53MS Main Road
P.O. Box 1179
Telephone O Southold. New York 11971
(631) 765-1892iJ01
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Thursday,
April 18, 2002, the following recommendation was made:
Moved by Melvyn Morris, seconded by Scott Hilary, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the
Amendment Request of SUSAN BRAVER & JOSEPH GULMI to Amend Permit #5266
for a 2' extension to the previously permitted house addition.
Located: 250 Pine Tree Court, Cutchogue. SCTM#98-1-7.11
Vote of Council: Ayes: All
Motion Carried
,a
Albert J. Krupski, President • • Town Hall
James King, Vice-President • p$VFFO~~'C 53095 Route 25
Artie Foster ~DY P.O. Box 1179
Ken Poliwoda G Southold, New York 11971-0959
Peggy A. Dickerson CD :
Telephone (631) 765-1892
F Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO: John Boufis
Building Dept.
FROM: Albert J. Krupski, Jr., President
Board of Trustees
DATE: March 5, 2002
RE: JOSEPH GULMI/SUSAN BRAVER
Permit #5266
The Board of Trustees has reviewed the above-captioned permit and has no objection to
allowing the applicant to continue with the project.
An application has been submitted by the homeowner to amend the permit and the
application will be addressed at our meeting on April 24, 2002.
The Board requests that the homeowners install the drywells and gutters as soon as
possible.
r •
New York State Department of Environmental Conservation _
Division of Environmental Permits, Region One
Building 40 - SUNY, Stony Brook, New York 11790-2356 v
Phone: (631) 444-0365 • FAX: (631) 444-0360 _
Website: www.dec.state.ny.us
Erin M. Crotty
Commissioner
March 4, 2002
Susan B. Braver and Joseph E. Gulmi
250 Pine Tree Court
Cutchogue, NY 11935
Dear Permittee:
Re: Braver and Gulmi Property
250 Pine Tree Court, Cutchogue
DEC No. 1-4738-02789/00001
In response to your inquiry concerning the slight increase in the width of the proposed
addition to your residence, please be advised that the Department has no objection to
this proposed extension. The addition in question is located on the eastern side of the
house, and the extra footage would be added to the northwest wall of the addition. We
understand that this increase would amount to approximately two feet, increasing the
width of the addition from approximately 21 to approximately 23 feet. This change will
not result in any part of the dwelling being located closer to the tidal wetland boundary
than is presently approved.
Very truly yours,
Karen Westerlind
Environmental Analyst
Albert J. Krupski, President • O.S~FF~~It • Town Hall
James King, Vice-President 53095 Route 25
Henry Smith P.O. Box 1179
Artie Foster W Southold, New York 11971-0959
Ken Poliwoda We
Telephone (631) 765-1892
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
January 29, 2001 TOWN OF SOUTHOLD
Ms. Susan Braver
Mr. Joseph Gulmi
250 Pine Tree Court
Cutchogue, New York 11935
RE: Pine Tree Road
Cutchogue, NY
SCTM#98-1-7.11
Dear Ms. Braver & Mr. Gulmi:
The following action was taken by the Board of Town Trustees during a Regular Meeting, held
on January 24, 2001, regarding the above matter.
WHEREAS, SUSAN BRAVER & JOSEPH GULMI applied to the Southold Town Trustees
for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application
dated January 3, 2001 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
January 24. 2001 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 SUSAN BRAVER &
JOSEPH GULMI for a Wetland Permit to construct 273 s.f. addition to existing single family
dwelling, hay bales be placed at the edge of work area. Gutters and drywells be installed on the
whole house to contain roof run-off. That the disturbed area be re-vegetated after construction
and that hay bales be placed no more than 20 feet from the addition.
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.
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.
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 when project is started and on
completion of said project.
FEES: NONE
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/cjc
cc: DEC
Building Department
j Board Of Southold Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. 572" DATEJanuary 241_2001. ;
i
ISSUED TO. SUSAN BRAVER & JOSEPH GULMI
< e
r
Pursuant to the provisions of Chapter 615 of the Laws of i
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 onJanuary.14., 2001
t and in consideration of the sum of $ 150..00 paid by
SUSAN BRAVER & JOSEPH GULMI
F .
x of Cutchogue, N. Y. and subject to the ' t
Terms and Conditions listed on the reverse side hereof, 4
of Southold Town Trustees authorizes and permits the following:
r y+ Wetland Permit to construct 273 s.f. addition to existing
sin le family dwelling, hay bales be placed at the edge of
worT area. Gutters and drywells be installed on the whole
house to contain roof run-off. That the disturbed area be
re-vegetated after construction and that hay bales bQ placed
all in accordance with the detailed specifications as presented in
the originating application. "
no more than 20 feet from the :addition. '
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to 1
be subscribed by a majority of the said Board as of f is date.
Er ~5~fF0(t~~,
o~, pG
o !
/ Henry Smith (absent)
Trustees
L: 4
TERMS and CONDITIONS
The Pertnittee SUSAN BRAVER & JOSEPH GULMI
residing at Cutchogue, N. Y, as
part of the consideration for the issuance of the Permit does understand and prescribe to the fol-
lowing:
1. That the said Board of Trustees and the Town of Southold are released from any and
all damages, or claims for damages, of suits arising directly at indirectly as a result of any oper-
ation performed pursuant to this permit, and the said Perm ttee will, at his or her own expense,
defend any and all such suits initiated by third patties, and the said Permittee ssaumes fall liability
with respect thereto, to the complete exclusion of the Board of Trustees of the Town of Southold
z. That this Permit is valid for a period of 24 mm which is considered to be the
estimated time required to complete the work involved, but should circumstances warrant, request
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 Permittee wishes
to maintain the structure or project involved, to provide evidence to anyone coocemed that auth-
orization was originally obtained.
! 4. That the work involved will be subject to the inspection and approval of the Board or
its agents, and non-compliance with the provisions of the originating application, may be cause for
revocation of this Permit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the wort
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along
the beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterarc rs
in the location of the work herein authorb:AA or if, in the opinion of the Board of Trustees, the
work shall cause unreasonable obsttucuon to free navigation, the said Permittee will be required,
upon due 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 Permittee of the compledon of the work auth-
orized.
9. That the Permittee 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.
O~og~FFO(,~cO
s
c Town Hall. 53095 Main Road
Ul P.O. Box 1179
Telephone Southold. New York 11971
(631) 765-1892 `171r~
SOUTHOLD TOWN
CONSERVATION ADVISORY COUNCIL
At the meeting of the Southold Town Conservation Advisory Council held Thursday, January
18, 2001, the following recommendation was made:
Moved by Bill McDermott, seconded by Bret Hedges, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A
CONDITION of the Wetland Permit Application of SUSAN BRAVER & JOSEPH GULMI
98-1-7.11 to construct a 273 sq.ft. addition to the existing single-family dwelling.
250 Pine Tree Court, Cutchogue
The CAC recommends Approval with the Condition that haybales are placed down and drywells
are installed to contain the roof run-off
Vote of Council: Ayes: All
Motion Carried
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o~OgpFFO(,~cG Town Hall
Albert J. Krupski, President hj. Gy 53095 Main Road
James King, Vice-President P.O. Box 1179
Henry Smith W Southold, New York 11971
Artie Foster "ep ~.g
Ken Poliwod8 Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD - 4
t.
LETTER OF REQUEST FOR AN AMENDMENT
DATE
~1esE P~~l l/ 1 f t~ih? 1
OWNER ,S,/s.9•? rz.3v~~ PHONE
ADDRESSv7,5- PIVC, L C-T yTt l(fB (i L~Fs
AGENT PHONE
ADDRESS
PROPERTY LOCATION.;? 37 ~?f %R f_E CZ_ - C urz_Pa,fc,o
TAX MAP NO. 29' - / - -7. / /
I/We 46-~-._ ~it•9~ cam- request an Amendment to Permit # S ~7G G
/YO e? CU. /~VYll t lei hP d 'i c
J3R
Signed By: cz r ,
AIV5Coryfs.€ cz-u's eel
Sr1Gdf
Albert J. Krupski, President • ~OgUFFO(,rc • Town Hall
James King, Vice-President hr~ 610 53095 Route 25
Henry Smith C P.O. Box 1179
Artie Foster tis Z Southold, New York 11971-0959
Ken Poliwoda CP Telephone (631) 765-1892
*1 Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
1 n
In the Matter of the Application 1
of
1 AFR 2 3=
hit tsiWAvaiw
COUNTY OF SUFFOLK)
STATE OF NEW YORK) _ .
AFFIDAVIT OF POSTING
I, ~!M I residing at 2s7~ Nj I R r Ci
C ~Qncxu2 "J_ nq~r
being duly sw , depose And say:
That on the 10 day of 490- , 2001, I personally posted the
property known as at5o ~liNc TRee C'o~ c{
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 of th y,
~
public he rin -1. Date hearing noted thereon to be held
tJV
Dated,
as ac)oa
( i nature)
Sworn to before me this
~a day of 200,'2
ar lic ~
l
JOHN CLARK
*bn EXr•;r DIIOQ~
gOfFO(~- _ Hall
Albert J. Krupski, President h.L.O~O V-0 53095 Main Road
James King, Vice-President o= :c P.O. Box 1179
Henry Smith y x Southold, New York 11971
Artie Foster p .F
Ken Poliwoda Telephone (516) 765-1892
Fax (516) 765-1823
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
Coastal Erosion Permit Application
i etland Permit Application
Grandfather Permit Application
Waiver/Amendment/Changes
eceived Applicati n:-4.3101
Received Fee:$
ISO-
-?7c-ompleted Application
Incomplete
SEQRA Classification: JAN - 3
Type I -Type II Unlisted
coordination: (date se t)
./-AC Referral Sent: / .3
xate of Inspection: /
Receipt of CAC Repor :
Lead Agency Determination:
Technical Review:
_ ublic Hearing Held: /
Resolution:
Name of Applicant .lf aW RA4VaA- ~ 6th 6yun/
Address o?37J P~?E TEE Cj, C v n--eo 6 (616- /y'' //93S
Phone Number : (6 31) 73'J- 7a a~
Suffolk County Tax Map Number: 1000 - y~-/- 71//
Property Location: e njDq,~f55 1 Boy£
(provide LILCO Pole distance to cross streets, and location)
AGENT:
(If applicable)
Address: \ b 1
Phone: \
FAX#:
1
BAd of Trustees Application.
GENERAL DATA
Land Area (in square feet) : ll Rc/CES
Area Zoning: ~QfsSi~t_ ?7iil
Previous use of property: lei-51bJFA172.44-
Intended use of property: /t 3/ r~fw/~.9s
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?
X No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
?C-L~-F.?»r ~Y Lwr~rait\\~C-
z l~ AdW .",Nn-OAI -TA C4y/277N<r Si2
~S/~7/~~-S7D.eY /~D 1~/I76~i+/~~TWO /dr~n/1~ u->j ¢~b st?LNY`f -~!?YC Ems)
2
Boa of Trustees Application*
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations : E xc A?,t r10A1 W-Vb con/s7x.ucj7 A)
7r4i S56L F-f ~TWo IfuNb QED +vA 5aredTY
Area of wetlands on lot: b square feet
Percent coverage of lot: G %
Closest distance between nearest existing structure and upland
edge of wetlands: ?V feet
Closest distance between nearest proposed structure and upland
edge of wetlands: 9a feet
Does the project involve excavation or filling?
No X Yes
If yes, how much material will be excavated? cubic yards
How much material will be filled? m cubic yards
Depth of which material will be removed or deposited:
feet
Proposed slope throughout the area of operations: 0
Manner in which material will be removed or deposited:
8 #CkU- '
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):
WYE-
3
B&d of Trustees Applicatio
County of Suffolk
State of New York
6 U5,f Al ~i4fjy~32 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 WI REVIEW OF THIS
APPLICATION.
Signature
SWORN TO BEFORE ME THIS DAY OF
Notary Public
HELENE D. HORNE
Notary Public, State of New York
No.4951364
Qualified in Suffolk Coun
Commission Expires May 22,6/
7
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES, TOWN OF SOUTHOLD
In the matter of applicant:
SUSi¢/?~/ £~s ~GrJ/~I/ SCTM#1000- 4P-~-7.11
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a
Permit from the Board of Trustees to:
£dN57XVC/' ~iV ~¢flDiT/Onl 7- ~zc/sTlN~ P~'~JE-CGIN~CSiN6cE +S~Ii~~
Cz73 S8-fr.~
2. That the property which is the subject of Environmental
Review ,is located adjacent to your property and is described as
follows:
/~E-siD£.v77,9~, 4o T sv ~Taf s/NGG~ F9nli~y mwF~.ctAiG
a50 Pi?£ 72fti Cr
3. That the project which is subject to Environmental Review
under Chapters 32, 37, or 97 of the Town Code is open to public
comment on: IIA Vl;l You may contact the Trustees Office at
765-1692 or in writing.
The above referenced proposal is under review of the Board of
Trustees of the Town of Southold and does not reference any
other agency that might have to review same proposal.
OWNERS NAME : f iC/fyc7~ ~6 Utis1/
MAILING ADDRESS: _aso
CUv h4VX Jf N`~ i! 35
PHONE 731/-VAa~!
Enc.: Copy of sketch or plan showing proposal for your
convenience.
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PROJECT I.D. NUMBER 61721 S EO
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I-PROJECT INFORMATION (To be completed by Aoplicant or Project soonsori
1. APPLICANT rSPONSCR I 2. PROJECT NAME
S SSA-~/ci<rio~c~c. e-,oh' (rv~ in
3. PROJECT LOCATION:
Municipality C-d Tr_.4~c ~j-//£ County
r s. PRECISE LOCATION (Street address and road intersections, prominent landmarks. etc., at 3rovOe maot
- o3 5z Ave_ reefE Q- / C(i, Lrh4 o~G el 4/ r" Cnka Pxe Za i c- 'CXrFAlsAVv)
cyQo55 57YZf.E-T15 Id JA f-TK.£-f A"9Ab
E. IS PROPOSED ACTION:
? New %Eseansion rl Modificationralteration
6. CESCRIBE PROJECT SRIEFLY:
fx-4v4-r041 (IVD -0A15Yn-6,c.rWA-' O-F.¢DD/T/oal Tri Ez[/SP7n/G-
S/~t'(rC~ f 6rnLy bWIFZ44A&'-, NO SFPT/c -XZ0441- s~p/roti~
. APACUNT OF 'AND AFF=•CTED:
!mtiall y$U SQ.
y --caws Ultimately S8-•IE~ 35i.0'
'-•IL' FROPOSED ACTICN CCMP' Y'NITH IS71NG 70NING OR OTHER =xIST1 NG 0 O USE BEST RICT:C'+5'
' fcc '.NO R.'to. aescnoe or!erty
'.HAT :S PPESENi .NID JE n.. N VICINITY OF mQC.:ECTn
~54esidersual -:ncustr.al Cammermal 7Agncuiture lRarsrForesu0oen space -.Otter
Cescnoe:
10 DOES ACTION 'NVCLVE A PERM] APPROVAL. DR FUNDING. NOW OR ULTIMATELY FRC;d AN r DTHER GCVE'NME4TAL AGENCY IFEDERAL-
STATEEEtDR LOCAL:?
IlY Yes LJ No 'f yes.:ist agencyisl and oermitlaoorovals
~ NY5 b~-. - a-voc~c~i~ul Fvx- c</~¢ylr>z~2- /~f.?~lnl~
11. COES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR AP°ROVA'
? yes 15,40 If yes. list attenc•/ name and oermd/aoproval
12. AS RESULT GF PROPOSED ACTION WILL =<ISTING PERMITIAPPROVAL REQUIRE MOOIFICATICN?
?'/?g No
1 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE -O THE BEST OF My <NCWLECGE
Aoolicanusponsor name: '7t w?yf~~'64o 'F Dare:
Signature:
If the action is in the Coastal Area, and you are a state acenc•y, complete the
Coastal Assessment Form beiere proceeding with this assessment
OVER
?AFT II-EN'/IFC `J 1„cvJ 'AMEMT ,-.J 7g cpr-Cle!ec oy Agent:
^I 7CE5 aC`CN _:iCc3C +'r =E. _ EB,GLo 'n i .•+°C=-. =:AT i". it ies, oocrclnats :ne:ev,ew :rocass aria use •r.e ='_a._ _rA~
7 "as r '+o
'•vtL_ AC7:CN REGEiVE CCCFCINA-C RE`rIEW AS ocQVICE7 =_a UPIL.S7=-: 4C7CNS N i \1YCRR, =aR7 i:757 :r `lo, a negacve .ec:arz
.may ce sucersecec oy nnctr.er nvowea agencv.
es ` No
C. CGULO AC71CN ?ESUL- .u ANY A0VE=SE E?==C:S ASSCCAPEC 'NITE! -=E PJL_CwI NG. Answers may .e nancwrl can. r :eglclel
;t. Existing air auaurr. surraca or ;rounowaier auaury or :canuty, noise .e•rels, exs;ing :.all is cattems. Salle masts arccucacn or Sfsz_
octenrlal for erasion. ]ramageor IIGaCmQ oroolems? Explant warty:
72 Aestneuc. agricultural. arcr.aeolaglcal. 'rls;on<. it Omer xararal or ,:mrural •esouress: or cpmmumr/ or -elGnecrnaaa crarac:er? Exolam
I
oo. Vegeiatton or laura.:Isn. sr.anfisn of wdallre soea:es. ;igndicanf raonals. jr mreffienea or encangerea acec:es'. Esclatn ]fletty:
I - -
G A Commune : axisnr.q plans or ;cats as ctfic:nlly aacetea. or a cnange in use or Intensity it use of :ano or other natural resCufcss7 Explain J:
I
I
slowtn. ;ucsecuent :emeiocmew. or relatea ac::vllles Ilkely :o ce 'nausea zy me arcaosac ac:icn? Et]l:irn ar!erly.
l
__nq -arm. Sner: :efm, pumwauve, or alner etfec:s not Icennried In C: L9? Exolaln :r:en•/.
:r. ~tner moat, Ina~c:nG :panges n vse of saner puanulY cr t•rpe or energp7 Eglam crsnv,
S' =?E _.R c..' -C SE.:C>r7RGVE?SY =E:.17E7 CTcNT!, L ACVE?SE wfACN:nc1T?L.MP4c7_-
_'es _ No t 'es. rxclam ]reay
=AFT i11-0Efc9MINATICN CF SiGNIFiCANCE ;To ce ccmoletaG av Agency)
:N57FUCTICNS: : or earn aayerse erect ioennfiep accve. cetermme .vnetner it is sucstantial. large. imccrtant or otnerNise signrfic
_aCn elfaC'. 3noUIC 5e assesses in Connec:ran 'Nlth tS la) Setting J.e. urcan cr rural); V ~rcoardity of occz; -ing; c; duration
rreverslbility: ;ei gecgracnlc state: ane it) .magnltuce. If iecessarv, ace attachments or reference suoocning materials. °asure
'?xclanaucns ocntam sur`ic:ent 7etali !a snow trial all re!evant aeverse ImoaCts nave teen icentihee ane adecuateiv aceressec.
- C::ecx :his ocx if !cu have ~dentifiec ane or .-tore ootentially large or significant aeverse ;moat's `.vnic.1 `.1A':
occur. -hen orccaeC cirec:vi :c :he FULL EAF anClor prepare a cositive• Ceclarancn.
C`ecx :his Cox :f you have oetermlnec, base, an the information and analysis above and any succor,:r.c
aoc mentar,cr,.:r.at ;he orpoosza ac cn ':TILL NOT result in
_any slgmfiCant aeverse envlrenmentai :meat:-
AND prcvlcz an a::ac.nments as necassarv, the reasons supCOrting thls Cai ermin atlCn:
,nl J( LC \ulne JI (r)vant. a,e ..II,C.! n ~m~O i,rn<'/ :,11[ ]r tu':OOn t~al['Jln[[I
;,cn]mre x <ereont.mr :r.a¢r n .[,a .¢ene! t.xna;err a '~uuu v _u;r•rnr .ram rrsoons.o,r m~.c[n
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
~ ~ ° ~r?,~~ /%tei5c~ / 3 5' ~G?£ /.LE ~ Cam: --~v~-~sfG,~ c~ ~Glg3.~
/ Acct-: AF . ,rGtLC£tl All" (x pn.gA'f9 37r PnCZ«-L l` - C~rcwrti~. /lf35`
NY
5 ' ~ -0 c-Ir 64ka)1 3 3o CLVN-"' ~ u vtr NYC! L~l-33u
~L_Cd C~TcAc~ c n"/e/f 3~
~<1a ~ ti a! 4-v ~?~re /fry ~.~e~ N`/u rs
0.6AX ssj
I
STATE OF NEW YORK
COUNTY OF SUFFOLK
;RN1314YPK9- , residing at
.R53 ?~'T sE cr
Gv vz kvGue. N Y 1/735' , being duly sworn, deposes and says
that o thn eme day of ,1"U9~eY ,28Q L_, deponent
mailed a true copy of the Notice set forth in the Board o°
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 of the Town of Southold; that said Notices were mailed at
the United States Post Office at Socrn~oc~. n/-Y- , that
said Notices were mailed to each of said persons by (certified)
(registe d) m
Sworn before me this
day of
, L9 0 /
Notaryy Public
HELENE D. HORNE
Notary Public, State of Newyork
No.4951364
Qualified in Suffolk County
Commission Expires May 22,G~,