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Home My WebLink AboutTR-5416Albert J. Krupski, President James King, Vice-President Attic Foster Ken Poli~voda 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 CERTIFICATE OF COMPLIANCE # 0035C Date April 28, 2005 THIS CERTIFIES thatthe single-family dwelling,deck & driveway At 4079 Main Bayview Rd., Southold Suffolk Count)' Tax Map # 78-2-t8.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 8/24/01pursuant to which Trustees Permit # 5416 Dated 9/19/01 Was issued, and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for a single-family dwelling, deck & driveway The certificate is issued to Peter J. Jacques aforesaid property. owner ofthe Authorized Signature Albert J. Krupski, President James King, Vice-President Artie Foster Ken Po]iwoda Peggs' 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 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction Y2 constructed Project complete, compliance inspection. O~ ~ 12-~'[~' Albert J. Krupski, President James King, Vice-President Hem'y Smith Artie Poster Ken Poliwoda December 20, 2001 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax [631) 765-1366 Mr. Matt D. [vans Suffolk Environmental Consulting, !nc. P.O. Box 2003 Bridgehampton, NY 11932 Re: PETER J. JACQUES 11655 Main Bay'view Rd., Southold SCTM#78-2-18.2 Dear Mr. 1vans: The folloxving action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, December 19, 200!: R~ES.~L~, ED. Lhat the Southold Town Board of Trustees .&PPROVE the Amendment to Permit ~¢54j 6 to reposition the locadon of the proposed dwelling 4' to the no:th:vest to maintaiv 10' frcm the side property boundm% This ~s not a determination fi.om any other agency. Lfyou have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees T~l~phoae (631) 765-1892 Town 'Ha~. 53095 M~in Ro~d P.O. Box 1179 Sovthold, New Yo~k 11971 SOUTVrOLD CONSERVATIOFI ADVISORY C01.J~CTI, At the meeting of the Southold Town Conservation Advisory Council held Thursday, December 13, 2001, the following recommendation was made: Moved by Drew Dillingham, seconded by Melvyn Morris, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Amendment Request of PETER J. JACQUES to Amend Permit #5416 to reposi[ion the location of the proposed dwelling 4' to the northwest to maintain 20' from the side property boundary. Located: 4079 Main Bayview Rd., Southold. SCTM#78-2-18.2 Vote of Council: Ayes: All Motion Carried Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO. ~'e~iJl~/t~ DATE: ..Sept:. ],9 ,....2001 ISSUED TO ................... ~e~e.~....~- · ...~ques .......................... Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893: and Chapter ~ of the Laws of the State of New York 1952; and the Southold Town Ordinance en- titled ."REGULATING AND THE PLACING OF OBSTRUGTIONS 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 . ~.~p:L~.. ~Lg.th, .20.01.., and in consideration of the sum of $...2~0~.00. paid by · .$~££oJk..Ez~.~onmen'~L..C. oz~s~]~:~.,.. Tz~c.; ........................ : ................. of ...]~c~eh~mp~o~.~ ............. N.Y. end subject to the Terms and Conditions listed on 'the reverse side hereof, of Southold Town Trustees authorizes and permits the foJlowinq: Wetland Pei~njt to coflstruot a two story house (t 775 sq. ft +/- footprint) with attached deck (240 sq. fl. +/-), pelp. dous driveway and septic system.sarvey showing the 50 foot set back with haybales during construction and drywells end gutters to contain roof-nm-o~ . all in accordance with the detai~ed specifications as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- by causes ifs Corporate Seal fo be affixed, and these p.resent~ to be subscribed by e'majorlty of the sa,d Board as of this date. Trustees TER~S ~nd CONDmONS The Pexm~ctee Peter J. Jacqim~ residing ac ~fiT0 :O~i~, R ..... ~ .... Read, ga-,itl-~,Ad N. Y~ as part of the consideration for the '~c~"of the Permit do~ ~lerstand and ptesctlbe to the fol- lowing: 1. That the said B<~xd of Trustees and the Town of ..~thold sxe released fz~,~ any and all dau~ges, or d-;,~ f0~ d,,~es, of su~s arising ~ o~ indirectly as · t~sult of any opet- for aa extension may be made to the Bom'd at 3. That this Permit dx<mid be retained indefinitely, or as long as the ~id P,.~ee ~ to maintain the structure or project involved, to provide evld~ce to anyone concerned ~.t anth- otlzation was originally obtained. 4. That the wodc involved will be subject to the inspectio~ =,~ approval of the Board or its agents, and non-compliance with. the provisiom of the otiglnat~g application, may be cause for revocation of this Permit by r--c~olufion of the said Board. 5. That there will be no un~tsonable interference with na~atlon as · muir of the work herein a~thorked. 6. That there shah be no interference with the tight of the public to Pe~ trod tepe~ alaog the beach between high and low water marks. 7. Ths~ if furore ol~'adons of the Town of 8outhold ~ the removal and/~ ahzratio~ ~n the location of the s~odc bexetn anttmt~nr~ed, or if, in the oplnkm o~ the Boasd o~ Tp _~__.'e~ the work shah cause unreasonable obstmcoon to free navigation, the said Pennittee ~ be required, upon due notice, to remove or alter this work or projec~ be~in ~ted ~dthon~ ezpemes to the Toga 8. That the said Board will be notified by the Permittee ot ~he c~letion of the work auth- odzed, 9. That the Perrait~ee will obtain all other permi~ and consents that may be ~equb'ed plemental to this permit which may be subject to revokz upon fa~u'e to Obt~tn same. Albert J. Krupski, President James King, Vice-President Henry Smith Axtie Foster Ken Poliwoda BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765-1366 September 26, 2001 Mr. Bruce Anderson Suffolk Enviromnental Consulting, Inc. PO Box 2003 Bridgehampton, NY 11932 Peter J. Jacques 4079 Main Bayview Road Southold, NY SCTM#78-2-18.2 Dear Mr. Anderson:: The following action was taken by the Board of Town Trustees during a Regular Meeting, held on September 19, 2001, regarding the above matter. WHEREAS, Suffolk Environmental Consulting, Inc. on behalf of Peter J. Jacques applied to the Southold Toxvn Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated August 24, 2001 WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and WHEREAS, a Public Heating xvas held by the Town Trustees with respect to said application on September 19, 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 Peter J. Jacques for a Wetland Permit to construct a two story house (1775 sq. fk +/- footprint) xvith attached deck (240 sq. ft. +/-), pervious driveway and septic system.survey showing the 50 foot set back with haybales during construction and drywells and gutters to contain roof-run-off. 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, · l~ru;ski, Jr. President, Board of Trustees AJK/cjc cc: DEC .Building Department Telephone (631) 765-1892 Tov~ Hull. P.O. Southold, New $0UTHOLD TOW'~ CONSERVATI0~ ADVISORY C01~C~, At the meeting of the Southold Town Conservation Advisory Council held Tuesday, September 11, 2001, the following recommendation was made: Moved by Scott Hilary, seconded by Bret Hedges, it was RESOLVED to recommend to the Southold Town Board of Trusiees DISAPPROVAL of the Wetland Permit Application of PETER J. JACQUES to construct a two-story (1,775 sq.ft. +/- footprint) with attached deck (240 sq.ft. +/-), pervious driveway, and septic system. 4079 ROW off of Main Bayview Rd., Southold. SCTM#78-2-18.2 The CAC recommends Disapproval because the proposed structure needs to be staked and labeled, and the wetland line needs to be flagged. Vote of Council: Ayes: All Motion Carried Suffolk Environmental Consulting, Inc. Newman Village, Main Street. El). Box 2003, Bridgehampton, Ne,.,,' York II 932-2003 (63 l} 537-5160 Fax: (6311537-5198 Bruce Anderson, M.S., President Hand Delivered August 22, 2001 Mr. Albert J. Krupski, President Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971 Re: Situate: SCTM #: Jacques property 11655 Main Bayview Road Southold, NY 1000-78-2-18.2 Dear Mr. Krupski, As you know, this Firm represents Peter J. Jacques who is seeking to construct a single family dwelling and related appurtenances on the above referenced property. Mr. Jacques had originally been granted a Letter of Non-Jurisdiction from your Board on November 4, 1999 determining "...that the constn~ction of a single family dwelling atut clearing qf properO' to be out of the Trustee Wetland jurisdiction..." Unfortunately, in the process of applying for a Iown of Southold Building Permit for the above referenced proposal, Trustees jurisdiction regarding wetlands setbacks had increased from the initial 75.0' to the present 100.0', resulting in this project requiring a Wetland Permit from your office. Enclosed herewith please find a completed Wetland Permit Application. Application contents are as follows: (1) Town of Southold Trustees Wetlands Permit Application; (2) Short Environmental Assessment Form; (3) Copy of the original NY State Department of Environmental Letter of Non- Jurisdiction, dated October 12, 1999, concerning subject proposal; (4) Copy of the original Town of Southold Building Letter of Non-Jurisdiction, dated November 4, 1999, concerning subject proposal; (5) Two surveys prepared by Peconic Surveyors showing all proposed structures, dated December 8, 2000; Hammarth/ 2 (6) Check made payable to the Town of Southold in the amount of $200.00 covering the requisite application fee. By way of this correspondence, and on behalf of Mr. Jacques, I request that you commence review of this application. Should you have any questions regarding this matter, please feel free to contact this office at any time. Thank you in advance for your cooperation. Sincerely, Matt D. Ivans attachment cc: P. Jacques 11/2~,'01 ~ED 11:2~ FA! $16 765 1366 $outhold Torn A¢¢ount£ng ~002 Town ~ $309~ Main P~ad P,O. ]BOX 11~9 ~outholc], Ne~ York 11971 Telephouo (516) 765-15~2 F~ (516) 765-18~ BOARD OF ' TOWN OF SOUTHOLD LE-rt'~,R OF REQUEST FOR AN A.I~ENDMENT DATE. ~ove~b~ 28r 20'01 PHOA~ 765 - 1033 OW~Z~ Peter J. Jacques · ADD~S .1~655 Bay~iew Road; Southold, NY AGENT ADDRESS PROP]~RTY LOCATION Matt D. I.vans PHONE (631) 537 - 5160 Suffolk'Environmental Consulting,--~nc. P.O. Box 2003; ~.~gehampton, NY 11932 Main Bayview Road; Southold, NY TAX MiAP NO. 1000-078-02-018.2 ~t}'e Matt D, Ivans rcqucst~Ameudme~toPermit# 5416 Applicant wishes to amend subject permit by repositioning the location of the proDosed dwelling four feet (4.0') to the northwest to maintain twenty feet (20.0') the side proDe/ty bou~arv. // Albert J. Krupski, President James King, Vice-President Henry Smith Artie Fester 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLI~ STATE OF NEW YORK) AFFIDAVIT OF POSTING I,~ ~.Z~.~ ',, , residing at being duly sworn, depose and sa~: t -- That on the ~ day of ~5¢. , 200t, I personally posted the property known as ~A~9~E~ 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 the. _ ~.g. ~e_of hearing noted thereon to be held 0~ ,~,~q,~ Dated: ~5¢, ~'~ ~'~/ Sworn to before me this day of 200, ( s~--ignature ) Matthew D. Notery Public of New No. 011V6053859 (~ualified in Suffolk CountY Commission Expires January 22, 200~ I1,'26.'01 ~ED 11:28 FAX SiN 78.~ PROOF OF M~IrZfNG OF NOTICE ATTAC~ CE~.TIF?Rn MAIL RECEIPTS Name ~ Peter R. Dooley: Theodore Eiring: Atilio & Marcia ZuDicich: John Swiskey: Francis & Maria McNamee: Walter & Pauline $charpf: Michael & Gary Zukas: Nicholas.& Claudia Bruno: Michael Zukas: Lawrence Heit & Cathy Haft: 4235 Main Bayview Road; Southold, NY 11971 51-20 67th St.; Woodside, NY 11377 43-09 25th Avenue; Astoria, NY 11103 PO Box 584; Southold, NY 11971 17 Skipper Drive; Islip, NY 11751 41-18th Ave.; Ronkonkoma, NY 11779 405 Bayberry Road; Southold~ NY 11971 47 Alpine Way; Huntington Station, NY 11746 305 Bayberry Road; South~ld, NY 11971 395 Broadway; ADt. A D; New York, NY 10013 STATE OF NEW C0[~NTY OF SU~TOLK Newman Village Condo; Main St. Matt D. Ivan_s__- Agent__, r~sicling at Bridgehampton, NY 11932 ,~ei~g d~ly sworn. ~cs~s an~ ti~ cn the Z~ day ~f ~, "_~- ae~unan~ =a~!ed ~D!ication, directed to each of ~e ~ove ~a~ed ~ers~ .. %d~sses Set o~0site ther~ respec=ive ~mes: ~t ~;f ~d persons a~ sh~ on the c~=snt ~ses~t roll S~a=es Pus= Offics at Bridgehampton , ~at said were mailed ~ each of sai~ Dersc~ ~ mall. ot~ ~li~ NOTICK TO ADJACENT PROPERT~ OWNER ~ o.F..~s~zl~;$, .zOm~ '0z sou~i~ou> In the matter of applicant: Jacque, s SCTM91000- 078-02-018,.2 YOU ~RE FF-REB? GIVEN NOTICE: 1. That it is t. he intent&on of the undersiqned =o request a permit from ~he Board of Trustees to: Modify the existing "in-~orce" Trustees Permit (No. 5416) to relocate'the proposed dwelling four feet (4.0') ~o~thwest in order to maintain twenty feet (20.0') from the ~ide property boundary. 2. That the ~ropert¥ which ~s the s~bJe¢~ of ~nvironmental .~ ~eview is locatsd adjacent to your proper~y~nd is described aa ~ollows: 4079 Main Bayview Road; Southold, NY 3. That the proje~= which is subject to Environmental Rsview under Chapters 32, 37, or ~7 of .the Town Code is op0n %0 public cD~nt on:~!ou may contact the TLm~s~ees O~fice at. ?~-189~ O= in writing. Trus%ess o~ the Town o~ $outhot~ and does no= referencs any 0~R$ NAI~: .Peter J. Jacoues Southold. NY .11971 PHO~ ~: . ~631) 765-10~3 Enc.: Co~ of sketc~ or plan showing proposal for your convenience. Suffolk Environmental Consulting, Inc. Newman Village. blain Street, P.O. Box 2003, Bridgehampton. New York 11932-2003 (6311 537-5160 Fax: 1631) 537-5198 Bruce Anderson. M.S.. President Hand-Delivered November 29, 2001 Mr. Albert J. Krupski, President Board of Town Trustees Town of Southold Town Hall 53095 Main Road; P.O. Box 1179 Southold, NY 11971 Re; Situate: SCTM#: Permit #: Jacques - Request for Permit Amendment Main Bayview Road Southold, NY 1000-078-02-018.2 5416 Dear Mr. Krupski, As you know, this Finn represents Mr. Jacques, owner of the above referenced property. Pursuant to the requirements of the Town of Southold Building Department concerning this property, an amendment to the existing "in-force" Trustees Permit referenced above is required to reflect a condition of said Building Department determination. Therefore, please find attached herewith: (l) Board of Town Trustees Letter of Request for an Amendment concerning subject property; (2) Proof of Mailing of Notice; (3) Notice to Adjacent Property Owner; (4) Affirmation by Owner; (5) Copy of the original Board of Southold Town Trustees Permit (No. 5416), dated September 19, 2001; and (6) Check made payable to the Town of Southold Trustees in order to both modify said Permit and extend said Permit. By way of this correspondence, and on behalf of Mr. Jacques, kindly modify and extend said Trustees Permit. Should you have any questions regarding this matter, please feel free to contact this office at any time. Thank you in advance for your cooperation. Sincerely, Matt D. Ivans cc: P. Jacques Albert J. Krupski, President John Holzapf~l, Vice Prosident Jim King Marlin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P. O. Box 1179 Southold, New York 11971 Tel~hono (516) 765-1892 Fax (516) 765-1823 Office Use only Coastal Erosion Permit Application X Wetland Permit Application Grandfather Permit Application Waiver/Amendmen~fCha~ges Received Application: Received Fee: $ ~k0~ __Completed Application Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date CAC Referral Sent: __Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: __Public Hearing Held: . I Resolution: Name of Applicant Peter J. Jacques Address 11185 Main Bayview Road Southold Southold, NY 11971 Phone Number(631) Suffolk County Tax Map Number: 1000-78- 2 - 18.2 Property Location: 4079 ROW off Main Bayview Road, (provide LILCO Pole #, distance to cross streets, and location) AGENT: Matt D. Ivans, Suffolk Environmental Consulting, Inc. Address: P.O. Box 2003 Bridgehampton, NY 11932 Phone Number: (631) 537-5160 Fax: #(631) 537-5198 Board of Trustees Application Land Area ( in square Area Zoning: R-40 GENERAL DATA feet): 40,545 s.f. Previous use of property: Undeveloped Intended use of property: Private residential Prior permits/approvals Agency NYSDEC Letter of Non-Jurisdiction for site improvements: Southold Letter of Non-Jurisdiction Date 10/12/99 11/4/99 No prior permits/approvals for site improvements. Has any permit/approval governmental agency? ever been revoked or suspended by a If yes, provide explanation: No Yes Project Description (use attachments if necessary) : Applicant proposes to construct a two story house (1775 sq. ft. +/- "footprint") with attached deck (240 sq. ft. +/-), pervious driveway, and septic system. 2 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwada 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 Or S~rFOL$) STATE OF NEW YORK) That on the day of , 200 , I personally posted the property known as 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 ~he ~ublic hgaring. Date of hearing noted thereon to be held~/~o~ / Dated: Sworn to before me this day of oo/ / __ N~ry Public Ou~l~¢~e¢ ,r S,.i]:lk County Commiss~or f:x[,ires January Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Applicant proposes to construct a single family dwelling with related appurtenances. Area of wetlands on lot: ± 9000 square feet Percent coverage of lot: ± 22% Closest distance between nearest existing structure and upland edge of wetlands: N/A feet Closest distance between nearest proposed structure and upland edge of wetlands: 77 +/- 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 material 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 deposk~gdD N/A """ AUG2 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): No impact to the wetlands anticipated due to the project design and the existence of other similar structures which have not produced any apparent impact to the wetlands. Board of Trustees Application COASTAL EROSION APPLICATION DATA N/A Purpose of Proposed Activity: Are wetlands present within 75 No Yes If Yes, how much material will be excavated? How much material will be filled? feet of the proposed activity? (cubic yards) (cubic yards; Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from the implementation of the project as proposed. (Use attachments if necessary) New York State Department of Environmental Conservation Division of Environmental Permits Rm 121, Building 40-SUNY Stony Brook, New York 11790-2356 Telephone {516) 444-0365 Facsimile {516) 444-0360 John P. Cahill Commissioner LETTER OF NON-JURISDICTION Peter J. Jacques 11185 Main Bayview Road Southold, NY 11971 Date: October 12, 1999 Re:l-4738-024d5/00001 Jacques Property ROW off Main Bayview Road Southold, NY SCTM # 1000-78-2-18.2 Dear Mr. Jacques: Based on the information you have submitted, the Environmental Conservation has determined that: New York State Department of The property landward of the 10 foot elevation contour, as shown on the survey prepared by Peconic Surveyors, P.C. on 8/12/99, and last revised on 8/25/99, is beyond the jurisdiction of Article 25 (Tidal Wetlands). Therefore, in accordance with the current Tidal Wetlands Land Use Regulations (6NYCRR Part 661) no permit is required under the Tidal Wetlands Act . Please be advised, however, that no construction, sedimentation, or disturbance of any kind may take place seaward of the tidal wetlands jurisdictional boundary, as indicated above, without a permit. It is your responsibility to ensure that all necessary precautions are taken to prevent any sedimentation or other alteration or disturbance to the ground surface or vegetation within Tidal Wetlands jurisdiction which may result from your project. Such precautions may include maintaining adequate work area between the tidal wetland jurisdictional boundary and your project (i.e. a 15' to 20' wide construction area) or erecting a temporary fence, barrier, or hay bale berm. Please be further advised that this letter does not relieve you of the responsibility of obtaining any necessary permits or ~pprovals from other agencies. CC: V~4r~ truly y~rs, D~'puty Permit Administrator Suffolk Environmental Consulting, Inc. BMHP File Albert J. Krupski, 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 November 4, 1999 Suffolk Environmental Consulting Inc. Matt D. Ivans P.O. Box 2003 . Bridgehampton NY 11932-2003 RE: PETER JACQUES SCTM #78-2-18.2 Dear Mr. Ivans, The Southold Town Board of Trustees reviewed the survey dated and received in our office on October 8, 1999 and determined that the construction of a single family dwelling and clearing of property to be out of the Trustee Wetland jurisdiction, under Chapter 97, of the Town Wetland Code, provided a row of staked haybales be placed at the "clearing limits" line shown on survey during construction. However, any activity within 75' of the Wetland line would require permits from this office. However, this determination is not a determination from any other agency.. If you have any further questions, please do not hesitate to call. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK/djh cc. Bldg. Dept. PART II- ENVIRONMEHTAL ASSESSMENT (To t,e comptete~, by Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 use the FULL FAF. ~ Yes [] No If yes, coordinate the re,~ew process and B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may he superseded by another JnvoNed agency. [] Yse [] I~o COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers ma)' be hendwrttten, if tegible) C1. Existing air quality, sulface or groundwater quality, noise lewis, existing traff~c patterns, soiid waste production or diepcoal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archeologica], historical or other natural or cultural resources; or community or neighbor'ncod character? E. xpisin briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitat, or threstened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted, or change Jn use or intensity of use of isnd or natural resources? F_xplaio briefly: C5. Growth, subsequent development, o~' related activities likely to he Induced by the pmpuaed action? E~lain C6. Long term, short term, cumulstive, or other effed~s not identified in C1 -C57 Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? F_.~lain briefly: D. WILL THE ~ROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARAC'TI"RISTICS THAT CAUSED THIE E~TABLISHMENT OF A CEA? []Yes ~-lNo ! D. iS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If yes, explain briefly PART III - DETERMINATION OF SIGNIFICANCE (To he completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is seb~antisl, large, important, or sthem~ise signir~enL Each effect si~ould be assessed in connection with its (a) es{ting (i.e. u~an or rural); (b) probability of ocourdng; (c) duration; (d) irreversibitity; (e) geographic scope; and (f) magnitude. If necessary, add affachments or r~erenco sepparltng motedate. Enaum that explenstJnos contain sufficient de~alt to a, hew that sil rrde',-ent edveme impacts have heen identified end edequately addreesed. If quastion O of Part II wee checked y~, the ge~rmination and significance must evaluate the potenfla~ impact of the proposed acflo~ on the envircomentsi chareotedstics of the CEA. [] Check this box ~f you have identified one or more poi[entially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL FAF and/or prepare a positNe declaration. ~-I Cl~ck this box if you have determined, based on the information and analysis above and any sapporting ducumentation, that the pr~ a~ion WILL NOT result in any significant adverse envinmmental impacts AND provide on attachments as necessary, the rsesena supporting th~s determination: Name of Lead Agency Print or Type Name of Respons~bio Officer Signature of Responsible Offal, er in Lead Agency Title of Responsibie Officer Signature of Preparer (if different From responsible offioer) 2 14-16-4 (9/~5)-Text 12 PROJECT I.D. NUMBER 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM[ For UNLISTED ACTIONS Only PART 1- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) I. APPLICANT/SPONSOR 2. PROJECT NAME Suffolk Environmental Consulting, Inc. Jacques 3. PROJECT LOCATION: Municipality Southold County Suffolk SEQR 4. PRECISE LOCATION (Street address and road interse~tons, prominent landmarks, etc. or provide map) 4079 ROW off Main Ba)Mew Road Southold. NY 5. IS PROPOSED ACTION: [] New [] Expaoa~on [] Modification/alt eration 6. DESCRIBE PROJECT BRIEFLY: Applicant proposes to construct a two story house ( 1775 sq. ff +/- "footprint") with attached deck (240 sq. fl. +/-), per~qous driveway, and septic system. 7. AMOUNT OF LAND EFFECTED: Initially < 0._~,_4 acres Ultimately < 0.4acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [~ Yes [] No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Residential [-hndustdal []Commemia~ []Agriculture I--IParYJForestJOpen space ~lOther Descdbe: Single family dwellings with related appurtenances. 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENT AGENCY (FEDERAL, STATE OR LOCAL)? [] Yes []No If yes, list agency(s) and permit~approvals 1 I. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No If yes, list agency(s) and permit/approvals NY State Department of Emfronmental Conservation "Letter of Non-Jurisdiction" 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] Y~ [] NO I CERTIFY THAT THE iNFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE App,icant~ponsor name:Signature: /~//~7- -~nvir°mnental C°nsulting" Inc' Date: . 08/22/01 // If the action is in the Coastal Area, and you are a state agency, eom plete the Coastal Assessment Form before proceeding with this assessment OVER Board of Trustees Application County of Suffolk State of New York Peter J. Jacques 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 H3LRMLESS 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) OP. REPRESENTATIVE{S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. EUZABETH A STATHI8 NO. 01ST6008173, Suffolk County T~m Ex~m~ Jun~ 8,20.~ ~- DAY OF ~2001 Name: 1000-78-2-17 1000-78-2-18.3 1000-78-2-18.4 1000-78-2-27 1000-78-2-26 1000-76-1-1 1000-76-l-3 1000-76-1--4 1000-76-1-5 1000-76-1-6 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: Peter R. Dooley, 4235 Main Ba.wciw Road, Southold, NY 11971 John Swiskey., P.O. Box 584, Southold. NY 11971 Theodore A, Eiring, 51-20 67th St.~ Woodside. NY 11377 Francis & Maria McNamee; 17 Skiper Drive; Islip. NY 1175 l Atilio and Marcia Zupicich. 43-09 25~h Ave., Astoria, NY l 1103 Walter W. and Paaline R. Scharpf. 4l 18' Ave., Roitkonkoma, NY I1779 Michael and Gab. Zukas, 405 Baybeny Road, Southold, NY 11971 Michael F. Zukas. 305 Baybeny Road; Southold, NY 11971 Nicholas J. and Claudia A. Bruno, 47 Alpine Way, Huntington Station, NY 11746 Lawrence B. Heit and Cathy Ha~, 395 Broadway, Apt. AD, New York. NY 10013 STATE OF NEW YORK COUNTY OF NEW YORK ~*'-~--~, residing at Newman Village; Main Street; Bridgehampton, NY, being duly sworn deposes and says that on the ~ day of August, 2001, deponent mailed a true copy of the Notice set forth in the Board of Trustees ~plication, directed to each of the above named persons at the addresses set opposite their 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 ~h;~c~h~ ~g~;~;n:e~a~ ~sU~;dm~Sto each of said person~rtifie~ (reg~t~ed) mail. -/e Sworn to ,before m/th~ Z{~ dayo(& .,200i - -- / Notary Public ilot Mat~ew O. lvan~ ~lualifie~ in Suffolk Courtly ~mmission Expires January ~2, L}O0 ~ Board of Trustees Application AUTHORIZATION (where applicant is not the owner) I, Peter J. Jacques residing at 11655 Bayview Road; Southold, NY 11971, do hereby authorize Bruce. A. Anderson, Suffolk Environmental Consulting, Inc. (Agent) to apply for permit(s) from the Southold Board of Trustees on my behalf. APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTHOLD TEST HOLE I~'~1 -SM SURVEY OF PROPERTY A T BA YVIE W TO IgN OF SOUTHOLD SUFFOLK COUNTY , N. Y. 1000-78-02-18.2 SCALR: I"=40 AU'S. 12. 1999 AUG. 25, 1999 (prop, hSD, ) FEB. ?, ZOO0 ( ~ ) AU~. I1~,~000 (.~11~ C~ I~. ) ~V. ~, ~0 'prop. hsD. ) 5'W c~ o '~'/ ~ ~l =40,545 sq. //' ~ ffi =MONUMENT · ~ ~ - ~TLA~S FLA6 · ~/ ELEVATIO~ TO ~C.v D. LIC NO 49618 ANY ALTERAn~' OR ADOInON' TO THIS ~.~'lS A VluLAnON~ ~= I~¢~ ~O~C.~O~ ~.C. I HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IT SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEY~ 1230 T~REET I 0 0 ~ /~tAy 4'~ 199% T'ES T SURVEY OF PROPERTY A T BA YVIE W TOWN OF SOUTHOLD SUFFOLK COUNTY , N. Y. 1000--2'8--02- AUG. 12, 1999 AUG. 25~ 1999 ( prop. I~e. ~V. ~ ~OCT ' pr~p. h~e. ) DEC. ~ 2000 .' w/s IJAe ) ~ 15, 200/ (~. hse. ~ =MONtJMENT ARE REFERENCED TO N C VD