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Home My WebLink AboutTR-5625Board Of $outhold Town Trustees SOUTHOLD, NEW YORK ~l[ ~ DATE: .~ept.25th.,....2002 PERMIT NO JOSEPH ZEVITS .......................................... ISSUED TO ............................. - ......... : .......... ': 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 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 B6ard adopted at a meeting held on .S.ept..£5.,. .... 207.~..., and in consideration of the sum of $ 200.00 .. paid by ~f~kl. E~3(~flm~ni-at~ C.q.l~u~Bg. ~. ~chalf..-of.-.Jna~Ph.''zevits f Bridgehampton .... N. Y. and ,ubinct to the o ....................................... ; : .......... reverse side hereof, Terms and Condihons hsted on the of Southold Town Trustees authorizes and permits the folk, wlng: Wetland permit to construct a !,600 square foot +/- ("footprint") dweHin§, ~n attached 416 square foot covered porch, end ~tt~ched square foot deck, pervious driveway and sanitary systenl- public water is to be utilized, mith the st~el~io~ that there be ~ 15foot .en tut/buyer on the landward side of the existing retaining wall- that the house contain gutters, leaders and drywall to contain the roof run-off- the plan is going to ~ve to show that before a permit wilt be issued - a line of haybales be placed during constructiott nt thc flfly foot tine to prevent materials from affecting Peconlc Bay IN WITNESS WHEREOF, The said Board of Trustees I~ore- by causes its Corporate Seal to be affixed, and these presonts to be subscribed by a'majority of the said Board as of this date. T~teet TERIGS ,,nd C. ONDmONS West Lane (Private Road) Southold, N. l~z~ of ~he coasidemtioa fm the ~ of -~ ~-~ o~O~lnO$ ~0 Nt~Ol s~-~lsn~l ~o ,'j] O~AO~d¥ ~G~URFACE SEWAGE DISPOSAL SYSTEM DESIGN BY' JOSEPH FISCHETTI, P.E. HOBART ROAD SOUTHOLD, N.Y. 11971 ~,~ I65/) 765 - 2954 ...... ~. ~,~.~ ~. ~ ~. ~o.~ ~ , ....¢~,- AREA=IS¢7~7 2F ~ vACANT EL.L.ING ' DW _ ~/I"fH pUBLIL' "" __- f ...... .~--,*"--'- SURVEY OF PROJ~RTY AT BA YVIE tY TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK wITH pUBL.IC wATER 1000-88-06-18.4 SCALE: 1"=30' NOV. 12, 2001 FEB. 6, ~OOE ( revision prop. hse. ) JUL Y 19, ~002 ( revision prop. hse. ) TEST HOLE ~00 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 CERTIFICATE OF COMPLIANCE # O006G Date 9/2/04 At THIS CERTIFIES that the dwelling, porch, and deck West Lane, Southold Suffolk County Tax Map # 88-6-18.4 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 1/28/02pursuant towhich Trustees Permit# 5625 Dated 9/25/02 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 new dwelling, porch, and deck The certificate is issued to Joseph Zevits aforesaid property. owner of the Authorized Signature Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall {oute 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 OU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES Y TO COMMENCEMENT OF THE WORK, TO MAKE AN ^ PRE O.STRUCT'O" ,,SPECT,O". ;~;"~;;'~S~-~RED A V,O~T'O" AND POSSIBLE REVOCAT,O" o~ '"= PERMIT. INSPECTION SCHEDULE ~//Pre-construction, hay bale line Ist day of construction ? ,/ ¼ constructed Project complete, compliance inspection- Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson 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 October 4, 2002 Suffolk Environmental Consulting Inc. PO Box 2003 Bridgehampton, NY 11932 RE: SCTM#88-~6-1&4 Joseph Zevits West Lane (Private Road) Southold, NY Dear Mr. Anderson The following action was taken by the Board of Town Trustees during a Regular Meeting, held on September 25, 2002, regarding the above matter. WHEREAS, Suffolk Environmental Consulting on behalf of Joseph Zevits applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 28, 2002. 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 September 25, 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 Joseph Zevits for a Wetland Permit to construct a 1,600 square foot +/- ("footprint") dwelling, an attached 416 square foot covered porch, and attached square foot deck, pervious driveway and sanitary system- public water is to be utilized.- with the stipulation that there be a 15foot non turf buffer on the landward side of the existing retaining wall - that the house contain gutters, leaders and drywell to contain the roof run-off- the plan is going to ,have to show that before a permit will be issued- a line ofhaybales be placed during construction at thefiftyfoot line to prevent tn ateriais from affecting Peconic Bay 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: $10.00 Very truly yours, Albert J. Krup§ki, Jr. President, Board of Trustees AJIrdcjc cc DEC Building Department 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 TO: Please be advised that your application, dated January 28. has been reviewed by this Board, at the regular meeting of ~p*~m~,~ ~. ~no~ and the following action was taken: Suffolk Environmental Consulting on behalf of Joseph Zevits 2002 ( 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 ts 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: Two Inspections 055.00 each TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES BY: CLERK, BOARD bF TRUSSES 't/98 Suffolk Environmental Consulting, Inc. Newman Village, Main Street. P.O. Box 2003, Bridgehampton, New York 11932 2003 (631) 537-5160 Fax: (631) 537-5198 Bruce Anderson, M.S.. President October 24, 2002 Southold Town Trustees Albert J. Krupski, President P.O. Box 1179 Southold, NY 11971-0950 Re: Zevits Property Situate: Cedar Beach, Southold SCTM# 1000-88-6-18.4 '~L:, 2 5 2002 Dear Mr. Kmpski: I received your conununiqu~ on the parcel referenced above indicating your Board's approval of the application and request for inspection fees. In satisfaction of the inspection fees, I enclose a check made payable to the Town of Southold in the amount of $10.00. Please forward the Trustee Permit directly to this office. Thank you. Bruce A. Anderson cc. Mr. Zevits Suffo Environmental Consulting, Inc. Newman Village, Main Street, PO. Box 2003. Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5198 Bruce Anderson, M.S., President October 15, 2002 Mr. Albert J. Krupski, President Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971 Re-' Situate: SCTM #: Zevits Wetlands Permit Private road west of Little Peconic Bay Lane; Southold, NY 1000-088-06-018.4 Dear Mr. Krupski, As you know, this Finn represents Joseph Zevits who is pending final approval from your Board for improvements upon the property referenced above. Pursuant to the Board of Trustees Public Heating regarding this matter, please find encl6sed herewith: (1) Revised survey of subject property, prepared by Peconic Surveyors, P.C, last dated October 7, 2002, indicating the requested items thereon (three [3] copies). For clarity, please note that the Board requested that the survey indicate the following items: 1) Two (2) drywells to be utilized by the proposed dwelling; 2) Line of Haybales located fifty feet (50.0') landward of the existing bulkhead; and 3) Non-Disturbance/Non-Fertilization Buffer extending fifteen feet (15.0') landward of the existing bulkhead. By way of this correspondence, and on behalf of Mr. Zevits, please review the enclosed surveys and issue the requested Town of Southold Board of Trustees Permit at your earliest opportunity. Should you have any questions regarding this matter, please feel free to contact this office at any time. Thank you in advance for your continued attention and consideration. Hammarth/ 2 Sincerely, Matt D. Ivans cc: J. Zevits Field Inspectio~ 9/18/02 Telephone (631) 765-1892 Town H',fl.[. 53095 ~ ~ P.O. Box 1179 Southold, New Yo~k 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, September 23, 2002, the following recommendation was made: Moved by Nicholas Dickerson, seconded by Drew Dillingham, it was ' RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit Application of JOSEPH ZEVI~r4~/~ct ~ 1,600 sq.ft. (footprint) dwelling; an attached 416 sq.ft, covered porch; an attached 440 sq.ft, deck; pervious driveway; and sanitary system. Public water is to be utilized. Located: West Lane, Southold. SCTM#88-6-18.4 The CAC recommends Approval of the application with the condition of a 15' non-turf buffer. Vote of Council: Ayes: All Motion Carried · Peter C. Leverich 28 Whistler Road Manhasset, NY 11030 Board of Trustees, Town of Southold ~ POB 1179 i~,: Southold, NY 11971 Dear Board Members: I am writing to you regarding the application, SCTM# 1000-088-06-0!8.4, of Joseph Zevits requesting a building permit. I own the property adjacent to Mr. Zevits's property on the west side. My address is 1200 West Lane, Southold, NY. I have enclosed a site diagram of the two properties that was prepared by my architect, Mark Schwartz of Cutchogue. Please note the difference in elevation at the west side of Mr. Zevit's property and the east side of my property. There is a drop off from 11.0 feet to 7.4 feet. The high elevation is Mr. Zevit's property and the low elevation is my property. This raises the concern that there may be a significant and damaging runoff of rainwater etc. from the Zevits property onto my lower lying property. My architect has suggested that dry wells be installed by Mr. Zevits to prevent this situation from becoming a problem. I have addressed this matter directly with Mr. Zevits and he has assured me that runoff will not be a problem. I want to go on record in the event that Mr. Zevits is wrong about this. Thank you for your consideration of my concern. Yours truly, Cc: Mr. Joseph Zevits Mr. Mark Schwartz / / Suffolk Environmental Consulting, Inc. Ncwman Village, Main Street, EO. Box 2003. Bridgehampton, New York 11932-2003 , (631) 537-5160 Fax: (631) 537-5198 Bru~ce Anderson, M.S.. President Via Facsimile and Regular Mailing February 1, 2002 Mr. Albert J. Krupski, President Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971 Re: Situate: SCTM #: Zevits Wetlands Permit application Private road west of Little Peconic Bay Lane; Southold, NY 1000-088-06-018.4 Dear Mr. Krupski, As you know, this Firm represents Joseph Zevits who is seeking improvements to the above referenced property. This office submitted an initial Town of Southold Board of Trustees Wetlands Permit application on January 24, 2002 concerning said improvements and shortly thereafter, was notified by your office that subject application will be scheduled before your Board for a public hearing on February 20, 2002. However, Mr. Zevits has contacted this office this morning requesting modifications to the initial proposal, therefore resulting in survey revisions and consequently, a modification request of the initial application before your Board. By way of this correspondence, and on behalf of Mr. Zevits, this office wishes to reschedule subject public hearing to March, 2002, in order for all pertinent information concerning this application be included within your records. Upon receipt of said information, this office will immediately forward same to your office. Should you have any questions regarding this matter, please feel free to contact this office at any time. Thank you in advance for your consideration. Sincerely, Matt D. Ivans cc: J. Zevits tq qq 1,2002 12: IPM SOU D ...... _ Suffolk Environmental Consulting, ][nc. Newman ViUag¢, Main $~'ect, P.O, Box 2003, Bridgchampt~n, New York [ 1932-2003 {631) 537-5160 Fax: (631) 537-5198 Btu. ce Anderson, M.S.. Presidcn~ _Via Fac~,imjle and R~. I,r M2ilino Februa~ 1, 2002 Mr. Albert I. Krup~i, President Town Hall 53095 Main Road P.O. Box I 179 Southold~ NY 11971 Re: Situate: Zevits Wetlands Permit application Private road west of Little Peceuic Bay Lane; Southold, NY 1000-088=06-018.4 Dear Mr. Kn~ps&i, As you know, this Yirm represents losaph Zevits who is seeking improvements to the above referenced property. This offi~ submittal ~n initial Town of Southold Board of Trustees Wetlands ?eamit application on January 24, 2002 ca~neerning said improvements and shortly thereafter, was notified by your office that subject applicalion will be scheduled before your Board for a public hearing on F~bmary 20, 2002. However, Mr. Zevi~ has contacted this office this morning requesting modifications to the initial proposal, theret*ore resulting in survey revisions and consequently, a modification request o£the initial application before your Board. By way of this correspondence, and on bchalfofMr. Zevits, this office wishes to reschedllle stlbject public hearing to March, 2002, in order for all pertinent information conc~ing this application be irmluded within your records. Upon receipt of sald information, this office will immediately forward sam~ to your office. Should you have any questio~ regarding this mallei-, please feel flee to contact this office at any tinle. Thank you in advance for your considerslion. Sincerely, Matt D, Irons P1 cc: J. Zavits COUNTY OF SUFFOLK REVISED PROJECT DESCRIPTION for ZEVITS Property Situate: Private Road west of Little Peconic Bay Lane; Southold, NY SCTM #: 1000-088-06-018.4 Applicant proposes to improve the above referenced property with a private single family dwelling with related appurtenances. Applicant proposes to construct a 1,600 square foot ~: ("footprint") dwelling; an attached 416 square foot covered porch; an attached 440 square foot deck; pervious driveway; and sanitary system. Public water is to be utilized. Suffolk Environmental Consulting, Inc. New,nan Village, Main Street, EO. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5198 Bruce Anderson, M.S., President Hand Delivered August 2, 2002 Mr. Albert J. Kmpski, President Town Hall 53095 Mam Road P.O. Box 1179 Southold, NY 11971 Re: Situate: SCTM #: Zevits property Private road west of Little Peconic Bay Lane; Southold, NY 1000-088-06-018.4 Dear Mr. Kmpski, As you know, this Firm represents Mr. and Mrs. Zevits, owners of the above referenced property, who wish to improve thereon. This office initially submitted an application for approval of same on January 24, 2002, however, m the interim, changes to the proposal have occurred. Therefore, this office requests certain modifications to the pending application. Please find enclosed herewith: (1) Revised Project Description (two [2] copies); and (2) Revised Survey of subject property, prepared by Peconic Surveyors, P.C., last dated July 19, 2002 (two [2] copies). Kindly review the enclosed items and add to our pending application in order to gain completeness of same and schedule for the next available Town of Southold Board of Trustees meeting for permit issuance. Should you have any questions regarding this matter, please contact this office at any time. Thank you in advance for your consideration and attention. Sincerely, Mart D. lvans cc: J. Zevits Albert J. Krupski, President John Holzapfel, Vice Presidont Jim King Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P. O. Box 1179 Southold, New York 11971 Telephone (631) 765-1892 Fax (631) 765-1823 Office Use only X Coastal Erosion Permit Application Wetland Permit Application Grandfather Permit Application Waiver/Amendment/Changes ~Received Application:t/~]~. ~ Received Fee: r Completed Application Incomplete SEQP~A Classification: Type I Type II Unlisted Coordination: (date sent) /CAC Referral Sent: ~-Date of Inspection: '~//~/0~ Receipt of CAC Report: Lead Agency Determination: Technical Review: /Public Hearing Held: Resolution: Name of Applicant Joseph Zevit Address 97 Ballot Avenue; Hillsdale, Phone Number(201) 594-0459 Suffolk County Tax Map Number: NJ 07642 1000-088-06-018.4 Property Location: Private Road west of Little Peconio Ba~ Lane; Ba~rview; Town of Southold, NY provide LILCO Pole %, distance to cross streets, and location) AGENT: Suffolk Environmental Consulting~ Inc. Address: P.O. Box 2003 Bridgeh~un~ton~ NY 11932 Phone Number: (631) 537-5160 Fax: #(631) 537-5198 Board of Trustees Application Land Area(in Area Zoning: Previous use of property: Intended use of property: GENERAL DATA square feet): 18~ 727 square feet Vacant Land Private single family dwelling with related appurtenances. Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval governmental agency? ever been revoked or suspended by a X No Yes If yes, provide explanation: Project Description (use attachments if necessary) : Applicant proposes to construct a 1, 500 sq. ft. _+ ("footprint") single family dwelling (four bedroom); an attached 800 sq. ft. _+ deck; a 625 sq. ft. _+ driveway; a sanitary system comprised of five (5) leaching pools and three (3) expansion pools. Public water is available and will be utilized. Board of Trustees Application WETL~ND/TRUSTEE LA~NDS APPLICATION DATA Purpose of the proposed operations: Construct a private single family dwelling with related appurtenances. Area of wetlands on lot: 0.0 Percent coverage of lot: 0.0 Closest distance between nearest edge of wetlands: N/A feet square feet % existing structure and upland Closest distance between nearest proposed structure and upland edge of wetlands: 97 ± 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 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): No impact to the wetlands anticipated due to the pro~ect design and the existence of other adjacent similar structures which have not produced any apparent impact to the wetlandsr including the existing wood bulkhead located along the southwestern property boundary. Board of Trustees Application COASTAL EROSION APPLICATION DATA N/A Purpose of Proposed Activity: Are wetlands present within 75 feet of the proposed activity? No Yes If Yes, how much material will be excavated? How much material will be filled? (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) NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Joseph Zevitz SCTM# 1000-088-06-018.4 YOU ARE HEREBY GIVEN NOTICE: 1. That is the intention of the undersigned to request a Permit from the Board of Trustees to: Applicant proposes to construct a 1,500 sq. ft. + ("footprint") single family dwelling (four bedroom); an attached 800 sq. ft. + deck; a 625 sq. ft. + driveway; a sanitary system comprised of five (5) leaching pools and three (3) expansion pools. Public water is available and will be utilized. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: Private Road west of Little Peconic Bar Lane; Ba~rview; Town of Southoldr NY 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. You may contact the Trustees Office at 765-1892 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: MAILING ADDRESS: Joseph Zevitz 97 Ballot Avenue; Hillsdale! NJ 07642 PHONE # : (631) 765-1625 Enc.: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Patricia Zevits Kelly: Michael Zevits: Peter C. Leverich: Jo~ce Katzell & Robert Zevits: Address: 2470 Rossett Street; Fort Lee, NJ 07024 2470 Rossett Street; Fort Lee, NJ 07024 28 Whistler Road; Manhasset, NY 11030 2470 Rossett Street; Fort Lee, NJ 07024 STATE OF NEW YORK COUNTY OF NEW YORK I, residing at Suffolk Environmental Consulting~ Inc.; Newman Village; Main Street;Bridgehampton~ lqY, being duly sworn deposes and says that on the day of , 2000, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, 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 Southold; that said Notices were mailed at the United States Post Office at Bri~gehampton, that said Notices were mailed~L~ each of sa~ persia b~ (certified) (registered) mail. ~ /~ /4 f Sworn to before me this ~T4' Notary Public Matthew O. Ivanl Notary Public of New Yod~ No. 011V6053859 Qualified in Suffolk CountY Commission Expires January 22, Board of Trustees Application County of Suffolk ) State of New York ) JOSEPH ZEVITS BEING DULY SWORN DEPOSES ~ND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) Ai~D THAT ALL STATEMENTS CONTAINED HEREIN ~qE 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 DAM3~GES 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 REPRESENTATIVE(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. SWORN BEFORE ME THIS //// /~gnature DAY OF O~/~..~u~..~ 2002 Board of Trustees Application AUTHORIZATION (where applicant is not the owner) I, JOSEPH ZEVITS residing at HILLSDALE, NJ, do hereby authorize Suffolk Environmental Consulting, Inc. (Agent) 97 BAYLOR AVENUE; to apply for permit(s> from the Southold Board of Trustees on my behalf. ~ (Own~s signature> 1 ~-16-4 (9/95)-Text 12 PROJECT I.D. NUMBER 617.20 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only SEQR PART t- PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR I 2. PROJECT NAME Suffolk Environmental Consulting Inc. [ ZEVITZ 3. PROJECT LOCATION: Municipality Southold County Suffolk 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc. or provide map) Private Road west of Little Peconic Bay Lane Bayview; Town of Southold, NY 5. IS PROPOSED ACTION: [] New [] Expansion [] Modificatio~/alteration DESCRIBE PROJECT BRIEFLY: Applicant proposes to construct a 1,500 sq. ff. ± ("footprint") single family dwelling (four bedroom); an attached 800 sq. ft. ± deck; a 625 sq. ft. ± driveway; a sanitary system comprised of five (5) leaching pools and three (3) expansion pools. Public water is available and will be utilized. 7. AMOUNT OF LAND EFFECTED: Initially <0.1 acres Ultimately <0.1 acres 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? [] Residentia~ I--hndustdal [--ICommercial []Agriculture Describe: Private single family residential. [-I parkJForest/Oben space [~Other 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 parmrdapprovals Town of Southold Trustees Permit/Approval. Suffolk County Department of Health Services ] 1. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [] Yes [] No If yes, list agency(s) and permit/approvals 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] yes [] No I CERTIFY THAT THE INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant~ponsor na~7 Environmental Consulting, Inc. Date: 01/14/02 Signature: ~'.~/ ~,~ .~--.~ ~ If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER Suffolk Environmental Consulting, Inc. Newman Village. Main Street, RO. Box 2003, Bridgehampton, New York 11932-2003 (631) 537-5160 Fax: (631) 537-5198 Bruce Anderson, M.S., President }land I}elivered January 24, 2002 Mr. Albert I. Krupski, President Town Hall 53095 Main Road P.O. Box 1179 Southold, NY 11971 Re: Situate: SCTM #: Zevits property Private road west of Little Peconic Bay Lane; Southold, NY 1000-088-06-018.4 Dear Mr. Krupski, This Firm represents loseph Zevits who is seeking Unprovements to the above referenced property. In order to do so, a Wetland Permit from your Board is required. 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) Survey prepared by Peconic Surveyors, P.C., last revised on November 12, 2001 showing all proposed and existing structures and wetlands (two [2] surveys); and (4) 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. Zevits, I request that you commence review of this application. Should you have any questions regarding this matter, or require additional information, please feel free to contact this office at any fane. Thank you in advance for your cooperation. Matt D. Ivans . enc. cc: J. Zevits PART II- ENVIRONMENTAL ASSESSMENT (To be completed by Agency} A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.127 use the FULL EAF. [] Yes [] No If yes, coordinate the m,/~w process and WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by ancther involved agency. [] Yes [] NO COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. F_)dating air quality, surface or groundwater quality, noise levels, existing traffic patterns, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archeologicel, histohcal or other natural or cultural resources; or community or neighborhood character'? Explain briefly: C3. Vegatation or fauns, fish, shellfish or wildlife spacles, significant habitat, or threatened or endangered speCies? Explain briefly: C4. A community's existing plans or goals as officially adD.ed, or change in use or intensity of use of land or natural resources? Explain briefly: CE,, Growth, s~bsequent development, or related activities likely to be induced by the proposed action? Explain bdefly: C6. Long term, shod term, cumulative, or other effects not identified in Ct -C57 Explain briefly: C7. Other impacts (including changes in use of either quantity or type of energy)? Explain briefly: D. WILL THE pROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CH~ERISTICS THAT CAUSED THE E~Tm~E~ ~ A ~? i--lyes i--INo 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 be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, datermice whether it is subefantlal, large, important, or othe~vlee algnifment. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irrevemibility; (e) gsogrophic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant ad.me impacts have been identified and adequately addressed. If question D of Part II was checked yes, the daterminsflon and sigeirmance must evaluate the pole~al impact of the pro~3sed action on the environmental charactedsflce of the CEA. [] Check this box if you have identified one or more potentially large or algnit'mant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. [] Check this box if you have determined, based on the infmmstion and analysis above and any supporting documentation, that the proposed action WILL NOT result in any significant edveme environmental impacts ANO provide on attachments as necessary, the resecns Name of Lead Agency print or Type Name of Responsible Officer Signature of Responsible Officer in Lead Agency Title of Responsible Offmer Signature of Preparer (if different From responsible officer) Date