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Home My WebLink AboutTR-5569 TERMS ilnd CONDmONS . . \, ,. ....... " ... ... ~ .. The Permittee H.^~TIÞr:E, Inc. residiagat 4~t; Alh-:O("Qr9 lho¡,,·s. SBHthald, N.. Y., as put" of !be coasidcradoa for !be ¡....'''''' of che PamIt does updeølaDd aod prescribe to (be foI· lowiøg: 1. That !be said Board of Tmstæs aod Ibe Town of Soucbold &110 reIeued &om my aod aU damages, or claims fot cIamop, of IU/ts adsiøg dúecdy or iadirec:dy as . IaIIIt of my opel' adoa perfoøucd piauaøt to Ibis penult, aod Ibe said 1'>-. lHee will, lit his or her own ar-. defeod my aod aU IIich IaiCS"I"IoI-d by Ihitd tudes, &ad !be said ¡>... .1'1-""-" fullliahIIJq wiIh œipect theteto, to (be ønpIeœ "--'-Lv. of !be Board of T~ of the TOWIi of ~ 2. That Ibis PemIIt is w1icI for . period of 24. mos. wIdch Js œos/-t,w' to be !be -""'...... time" tequired to ~ !be wod< Inwhecl, but IIhoaJd ~...... waøaør, request for an ~,)Q may be made to (be Board at a law: cIaœ. 3. That Ibis Permit sbouId be ...t.Iøed iadef"wtdy, or as l00g as (be said PamItree wishes to "m.;....i" !be structure or project løwlved, to provide evideaœ to &ß7ODe cooœraed chat amh- orization was originally obtained. 4. That Ibe work 1øw1¥Cd will. be subject to the ¡.,~ &ad approoal of !be Board at Its agents, and I1OC1-<IDmJ'Iimœ with "(be provisioas of !be orIgI....,;..g appliadoa. ØMJ be caase for revocation of this PamIt by resolution of (be said Board. 5. That Ihere will. be 00 WIft'Osoo,We Interfereoœ wiIh aavigadoa. as a IaIIIt of !be wod: bereIø aùtborized. " 6. That Ihere sball be DO løterfereoœ with the right of (be pubIk to pus &ad repass a10ag !be beach between high and ~ water marks. " 7. That ilfuture operatioas of (be Town of Soutb9Id teqaúe !be œmova1 ud/or aIœndoas In !be !oaooo,. of !be wod< bereIø ..."'-d>-~~. or if, In (be opIaioa of !be Board of Truscees, the" work sbaU caase wueasoaabIe obstrucøon to free aaYigaioo, !be said P I .oIlI~ will. be rec¡uired. apoo due IIOCÍ<e, to remove or alter Ibis work or project bereIø stated wicbouc e.¡>eØIeS to (be Town of Souehold. " .;, 8. That Ibe said Board will be ootilied by the Permittee Ot the ~" of !be wadt amh- orized. 51. That (be PamIttee will obtain all other permits &ad CONeDci chat ØMJ be required ~ p1emental to this permit wbkh may be aubject to rewire upoa faUøre to oIxaIø woe. , ,,----¡".. " " " " " " " " " " , , , , , , " , "," " , , ,,"". ." . . .", " , , , , " , , " "" ., Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Keu Poliwoda . . Town Hall 53095 Main !Wad P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Catherine Mesiano Inc. on behalf of MATINE, INC. please be advised that your application. dated March 1, 2002 has been reviewed by this Board, at the regular meeting of M~y 7.7. 7.007. and the following action was taken: (-1l-) Application Approved (see below) (____) Application Denied (see below) (____) Application Tabled (see below) If your application is approved as noted above. a permit fee is now due. Make check or money order payable to the Southold Town Trustees, The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary, COMPUTATION OF PERMIT FEES: Two Inspections @$5.00 r ~f!!D JJ: I r; æo~ TOTAL FEES DUE: $ 10.00 SIGNED: {:à¿.¡ ~ ~,~~..t. 9., PRESIDENT, BOARD OF TRUSTEES £E~~:;S;E~ . BY: 4/98 . (f\Ot--\: ^º- INSPECTION SCHEDULE -Ø-construction, hay bale line ~ 1st day of construction J Y:. constructed VProject complete, compliance inspection. . 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 "" 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 ---.X Pre-construction, hay bale line 1 sl day of construction Y. constructed -X Project complete, compliance inspection. MATINE, INC. 435Albacore Drive, Southold, NY · , Telephone (631) 765-1892 Town fWl. 53095 Main Roa<. P.O. Box 1179 Southold. New York 11971 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, March 18,2002, the following recommendation was made: Moved by Scott Hilary, seconded by DrewDillingham, it was RESOLVED to recommend to the Southold Town Board ofTrustees DISAPPROVAL of the Wetland Permit Application of MATlNE, INC. for the construction of a 62'X 52' single-family dwelfing, on-site sewage disposal system, pervious driveway and public water supply. Located: 435 Albacore Dr" Southold. SCTM#57-1-20 The CAC recommends Disapproval of the application as submitted and recommends a 100' non-disturbance buffer. Vote of Council: Ayes: All Motion Carried t~ -,1 CATHERINE MESIANO.INC. 12 MILL POND LANE EAST MORICHES, NY 11940 631-878-8951 February 27,2002 South old Board of Town Trustees Box 1971 Southold, NY 11971 H:ti ¿ 8 ATT: Charlotte RE: MaTine Inc. ' 435 Albacore Drive. Southold SCTM # 1000-57-1-20 Dear Charlotte: Enclosed is an application package for the above referenced applicant. Please note that the application fee. disclosure, release and authorization will be hand- delivered to your office by Mr, Hurtado. Should you have any questions, please do not hesitate to call, Thank you. Very truly yours. C~;""O, P"",;denl Enclosures , 'c< r:..·· ' ' , f, ,I . . ,i , -1- I I <:>- Z ____/ ! I ~ ¡; , , :; "t. ,~ . L; . '" \ . I~ ¡, 1\,1: \ .!! :.,~'''' '_"11· 1", . )~I"1i ~I'¡ ~:"I' ,)1.',' . ,~", ~JI.:,:... ',,-:, ',,, "I"~ ~:~: ; ,no '1 " 'I< " '< ;¡; " 5 '=' ~ " ~ . .''1 "1' 'iL" ,I< , ! ., t'. "¡ ri," I':~" : 'iÌ".I , It ..-, j':, '~: -~ ! I~'.<.....'., I' ":~ i~'":~ ,H :~< . . MAIliNG ADDRESS: P.O. Box 1179 Southold. NY 11971 WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON \)f SOUl; .ss ø~ + +.. u> i!;g ~. ~ ~W OFFICE WCATION: Town Hall Annex 54375 State Route 25 (cor. Main Rd. & Youngs Ave.! Southold, NY Telephone: 631 765·1938 Fax: 631 765-3136 PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Town of South old Board of Tmstees Senior Environmental Plannp'/ L WRP Coordinator ~ From: Mark Terry, Date: June 21. 2005 Re: Request for Pennit for J&C Holdings LP SCTM#1000-57-1-20 The proposed action involves the construction ofa 16' x 21' toot rear deck at the north side of an existing dwelling. The proposed action is located 55' from a freshwater wetland system. A 30' non- disturbance buffer from the wetland boundary already exists on the parcel. The proposed action has been re\'iewed to Chapter 95, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (L WRP) Policy Standards. Based upon the infonnation provided on the L WRP Consistency Assessment Fonn submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the L WRP provided that tbe following best management practices are applied and implemented. I. The applicant shaH employ erosion and sediment controls (haybales and silt fencing) landward of the wetland system. 2. The area demonstrates a high groundwater table with seasonal fluctuations. The test hole indicates water in brown fine to course sand at 6.2 feet. Therefore, to fnrther the intent of L WRP Policies 5, 6, and 8 and to protect ground and surface water quality ofthe wetland systems no CCA treated wood. oil based preservatives containinl! creosote (CRT) or pentachlorophenol (PCP). applied to the surface of wood materials shall be permitted in the construction materials of the deck. The applicant shall use decay resistant wood (cedar. black walnut) etc. Pursuant to Chapter 95, the Board ofTmstees shaH consider this recommendation in preparing its written detennination regarding the consistency of the proposed action. Please contact me at (631) 765-1938 if you have any questions regarding the above. Cc: Conservation Advisory Council Heather Tetrault, Em'ironmental Analyst Albert J. Krupski. President James King, Vice-President Artie Foster Ken Poliwoda Peggy A Dickerson Town Hall 53095 !Wute 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax 1.631> 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0060C Date Sept. 19, 2005 THIS CERTIFIES that the single-family dwelling, deck, and driveway At 435 Albacore Dr., Southold Suffolk County Tax Map # 57-1-20 Conforms to the application for a Trustees Permit heretofore fIled in this office Dated 11/19/04 pursuant to which Trustees Permit # 6051 Dated 12/20/04 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 and driveway The certificate is issued to Matine, Inc. owner of the aforesaid property. dl~·.I 9· ~. f}. Authorized Signature -..&r.. . . . -:"':'. ! / L , <....., 'ë .....-t:-.,. L- r- .--. 1"\ .' . ./. 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J/c'U-'~.... 'i--<-<- ~ CL ~ ..¿~/ Þ ~q/:'A-t c'-;J14~ "'VU4..-! ~ -1JLK ~ ~~~.2 /'~~" ~ ., , Ll ~ / ---i ¿lJ A-V7"<---1..- C£. ~~....z I' ~ .~ ...-è..¿...c;:;;:;".-<-... '-~.rz-P J>Þ. . A »" 1 .:4.~ -1,r.:.. ~ ",' _ " . .Le'&<.., . /.,¿~ =~ .</ £- X,,-,- 11:-,., ·h ../1 ~ I /~ i7"~ ~<"'c-&~~;,r- --. . ~~:. ",,{ þ~~ /--r2 ~ Zttß, ,/ ,):,'7 ./ ~ ~.. 0 / "'- Æ ,/ l·c-l~ -4-e-,4~ ' ~ . . Albert J. Krupski, President James King, Vice-Pt-esident Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 119ìl-0959 Telephone 16311 765-1892 Fax 16311 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 22, 2005 Mr, John Hurtado J&C Holdings LP P.O. Box 1925 Southold, NY 11971 RE: 435 ALBACORE DR., SOUTHOLD SCTM#57 -1-20 Dear Mr, Hurtado: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, June 22, 2005: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit #6051 to include a new 16'X 25' rear deck, and as depicted on the survey prepared by John T, Metzger last dated July 21, 2004. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892, Sincerely, 17. ~·-I9· ~''r' Albert J, Krupski, Jr. President, Board of Trustees AJK:lms . . SOUTHOLD SHORES GROlJP, INC. 590 Tarpon Drive PO Box 870 Southold, NY 11971 Board of T O\\n Trustees Town of SOUlhold Town Hall 53095 Route 25 PO Box I I 79 Southold. NY I 1971-0959 ~~.'~IU~ I\n JUN 27 2005 llidJ June 23. 2005 SOlltli lic~ Im'in ~,' .' '"., Dear Sirs and Madams: Ref: Meeting Agenda. June 22, 2005, Item V1.2. Pennit #6051 I have three concerns about the referenced permit. Concern I: No notification was gi\'en for the above permit. Please ensure that in future we receive ail appropriate notifications of permits. including those already underway. Southold Shores Group. Inc. purchased lot lOOO- 57-1-1 l in July oflast year. However. as of this date we ha\'e received no notitìcations of permits for the lots adjacent to our property. Concern 2: Insufficient attention to the wetlands marked by the DEC [fjust the remaining wetland markers are used as the basis of permit approvals, there will be many occasions when permits will be approved even though the changes are too close to the designated wetlands. Some time ago the DEC marked the wetland areas in our neighborhood. Markers were placed at the edge of each area. Since then, some of these markers have been removed by person or persons unknown. It appears that the Tru&ees base their measurements of distance from wetlands based on the existing markers rather than maps created by the DEe. This will lead to approval of permits that should be denied. . . Concern 3: Inadequate penalties for wetland violations What are the penalties for building to close to wetlands? I am concerned that ifit is eventually discovered that an owner or builder is found to ha\'e built too close to wetlands. the penalties are too low to deter such violations. Sincerely. ìiV) ¿Ad Jl=___~ Michael R. Wilson President Q. . . ~ ;;;;;"~~I~ ì~~ '1 ~d~ m,r,. rLi1:ufSl-i Þ 1\ C}oo") )Jt: IE (G !E ~ ~'-,-: F\ I:" U1 " I I .\ . \ Û JUN 1 5 20uJ .~ 'I /} b /' /I. Southold ToW\! ~ ~ ~2 " Board of TruslBes f~ L~, £.4{ iÆ-d ¿kµ a. .1.ermufJ7<n7-LÆJ 1~~W cl-.. ~ ~ ~ //UcÁ- 7!7'~ ¡¿,;;¡;~ ;Jf '~k~ ~ /t}¿ ~ ')-7Þú. ~ r ,J.DCtU! 13~/dvw m-' ~. cl.u~ ::«;1 ~ 1UJéf:d: Iv:f.t;; JßYt.S,+,,,,,- ~. itt&.æu ~~.¡Ir t1 /2.e-/;,:/Jftv ~g~L~ CJ"ì1./ ß). /000 - S7- 0/52-0 ð'x-- ~^ ~ S"'../~ JJr.Þ> ~ Jfrj -ft ~~ 1,.,. ~. í~il/}{U vv Ii flY71-¡f --10 ~ ct-- /(,;,¡LJ.$ 1M, O./M- "'rul'/J/' M..LtJR II~ . /- J-k. 1dM- ~Þ-- t( ¡.µ ik (~ 4.f~1' /. '1 VrL ~ th..-i WI!' aR~ KlI £PX~ht . fb.) I IMW ~ .~khK4 c¿L~ ~,~ ß+-dru. k" fjJ/ ;~ fttkM ~-I f:ßn(Sð'~ r~ /jµ/J!.t-fç a-M tv#~/~jj~. (Ð. . . . hn~j ~.~ ~ ~/~ ~/Uç~~ t~ ~.~ ~. t?'YJCuj )~ C!An/.u0 ¥ ~ ' . rv !tetJ{I~ 'I}~6. uu~Z6,:;urlxw..CR" 4,' #~ ~ fuu.--I-¿ ß-r-~ 7-#w&-.v·4 ;Bo~ L ~ - b~.{hJ~ ~.~ ~o·~a.~~~~ç~ {iti~4~, 10 XI1 ~/~ a ~ -!o iI....,j~ ¡Lj'-Ik~~w~ fX--'f~~·· ¡).u~ iV/'/{ /'r;-4 db li- ~. ~ ìJà</ ckIß¡¡ auJ,w J~ (~ ¿/fhvyrcl Þ IN. '?f~,Lt:r- "-- þ jPtJ¿ (kwtt'lf'1 .jkw ~ ./fð~~ t1 ,()y7ßf~f ¡nuøJ-O¡' cd- \' Offi'</K~f~ b- Ol~Uf (I ó- cY::~~ ß/:vbi#-uV <]' " 3~ l~j);· 'Ý;; uÝ-fi¡Ü )¡ y. ;1 f7 ! . . Telephone (631)765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., June 14,2005, the following recommendation was made: Moved by Don Wilder, seconded by Tom Schlichter, it was RESOVLED to recommend to the Southold Town Board ofTrustees APPROVAL WITH A CONDITION of the application of J&C HOLDINGS LP to Amend Permit #6051 to include a new 16'X 25' rear déck. Located: 435 Albacore Dr., Southold. SCTM#57-1-20 The CAC recommends Approval of the application with the Condition the area seaward of the deck remains completely natural. Vote of Council: Ayes: All Motion Carried . Albert ,1. Krupski, President James King. Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTH OLD Board of Trustees Field Inspection iYi3 j oS Date Address__~~) fI-1l,c;, C6\.---->- Owner \ ,) c~, ".., ~-t « ç~ SCTM# Inspected by Findings j 7 - I .. 2ò . I 1'.. ~~... \ h c:L /~ 'Iei'<v_ \ !- ~l~ P , (' ~ l v,...,--<: ¡ll/'R..~ . Town Hall 53095 Route 25 P.O. Box 1179 Southold. New York 11971-0959 Telephone (631) 765-1892 Fax 1631) 765-6641 r-e-p \~C 'f'..J \ n k~ H-UL- Photos taken --- ------ A.II.'f:"n ,f. Ieki, l-'rE:sJd"~nt ,J8.Jn¡"" f\jng. "'j(',--,-Pre~jdént Artie Foster Ken t'('ti....,î¡da p-¿>g~'}. A. Dickerson I,.-,·....n H~1tJ :1:jU~!~i F:IJut,· ..:;~ P.O. Box 1179 Suuthold, New York 1197l-Ü~ Telephlme It,.:3 U 765-1B92 FIiX 1·6,3 1.1 765·-1:~66 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, haYbalelinell'lø~ {tC...~.<.:.,... ~~L ß ~ ~ b oZ.. ~"'I""<. (r . 1st day of construction ~J...-" Y. cOnstructed \.7 Project complete, compliance inspection. {i>e í?~,J 7/:J(01.. ~iLfÅ.-.A.v~· qf¡"ID) ø". ,. . . 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 20, 2004 Matine, Inc. P.O. Box 1925 Southold, NY 11971 RE: 435 ALBACORE DRIVE, SOUTHOLD SCTM# 57-1-20 Dear Mr. Hurtado: The Board of Town Trustees took the following action during its regular meeting held on Monday December 20, 2004, regarding the above matter: WHEREAS, MATlNE, INC. applied to the Southold Town Trustr;ðs for a permit under the provisions of Chapter 97 of the South old Town Code, the Wetland Ordinance of the Town of Southold, application dated November 19, 2004, anc 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 December 20, 2004, 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 standards set forth in Chapter 97 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, 2 . . RESOLVED, that the Board of Trustees approve the application of MATINE, INC. to construct a 62' X 52' single-family dwelling and pervious driveway with the stipulation that there is a 30' non disturbance buffer to the fresh water wetland and all as depicted on the plan surveyed by Joseph Ingegno and last dated February 1, 2001. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) This is not a determination from any other agency. Fees: $0.00 Very truly yours, ~?~'ç, Albert J. Krupski, Jr. President, Board of Trustees AJKlhct . . RESOLUTION RESOLVED that the Board of Trustees of the Town of Southold hereby finds that the application of MATINE, INC. more fully described in the public hearing item #2 of the Trustee agenda dated Mon. December 20, 2004, is classified as a Type II Action pursuant to SEQRA Rules and Regulations, and is not subject to review under SEQRA. ( . Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the South old Town Conservation Advisory Council held Tues., December 7,2004, the following recommendation was made: Moved by Don Wilder, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of MATINE, INC. requests a Wetland Permit to construct a 62'X 52' single-family dwelling and pervious driveway. Located: 435 Albacore Dr., Southold. SCTM#57-1-20 Vote of Council: Ayes: All Motion Carried .~ j"~~ . ~~,:.:..::.~ ,. < "~""''''<':Ir'''~~ -' - '. - "~',.~ ~~ '~~?.:i.tt "-" --.... 11115/04 Field Inspection. . t. .. . ,j .' . /. .j :' . .'~ l'~ ;;.No . - . . .' .- .' 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Bid ~ No .lP{ rJo) II~O City,Stðte.¿,p(OC.O , o V) I:' LOC3t'on Cod"! B ;!; <;5 <.- A 11$<:"-. 1r<.. ,/..-. ,--::,.c:: <: _. ,.~.I.. < Á.ç:" 22. Off. NO. lAW SECTION ,u8 Cl CAr DEG AIT NAME OF OFFENSE m 2J No of VictIms C , , 24. NO.ofSu'>Je(t!o ~<-/¡' 3 25.Person rype;co..ComplaiRðnt OT ; Other PI" PeßOn Inte~¡ewed PRa Penon ReportingWl..WitnesliNl..NOt 1nte1Vlewed VI "Victim I 2611ictlm alsO wmplainant 0 YON , ~ TYPEINO NAME (LAST, fiRST. MIDDLE, TITLE) Oateof STREET NO., STREET NAME, ØlDG. NO., APt. NO., CITY. STAT£, liP Telephone No. Z Birth 0 l";",-:' ·~C J-.. F '" V:J -¡ ------- ¡ /<r/ 0: ::'/,.--- , F"lc, 'c " t" Ie' w /_7£..r./____ i,...-, " .. ," ~ , ... 0 G ~ l- e U H 0 '" '" e , ~ n. D¡tte of Birth 128 Age 29.Se.. 30 RClce I 31. Ethnic I J2 H,wdccClD 1:33 Re~denceStðtU\ OTemp Re~,_Foreign Nat. ~ I I OM OF o White 0 BIClck 0 Other o Hii)ðnic 0 Unk. 0 Ye~ 8 Re~loent '3 Tourt~t 0 Student ~ Other , " ,. I Pi u o Indian 0 Asian 0 Unlc. o Non·Hispanlc 0 No Commuter Military 0 Home eu DUnk 34.TVpelNo 35. Name (Lan. First, MIddle) 36. AliasINlclc:nameJMaiden Name (last, first, M!ddle) J7 Apparent Condition K. Z o ImpaIred Drugs o MentClIDls DUnk. 0 o ImpoJlred Alco o Injl JI 0 AppNorm '" 0: I 39,PhoneNo. 40. Social Secunty No ~ 3B. Addre'>s (Street No., Street Name. Bldg No. Apt No., CitV, Staœ.lip) o Home l .. <-0 o Work V~ 142 Age 47,OCCuPCltion ~<- 41 Date of Birth Ir·SCA 44. Race 4s.EthnIC I f6Skln ..~ I OM 0 F o White 0 alack D Other o Hispanic 0 Unk o Light 0 Dark 0 Unk M "'~ "g¡ Du o Indian 0 As!an DUnk. o Non.Hispanic o Medium 0 Other "'.. I" I S5 Addre~~ ìò 48,Heightl 49 we'9ht Hair ') 1 €ye~ ')1 Gla~se~ 53 Budd 154 Employer/School .. Z DYes 0 Contact:~ o Sm¡tll 0 largE' ¡¡; 0"0 o Med,um ~ ~ ')6. ScarY MClrkslTa[tOos (De\ulbeJ 57.Mlsc [] ~: - ~y 3~~nti¡Vf D~ak~"o,: SerhdNo. Description Vølue 0 Statu!' Modo' LJ >- GJ <- 0: s9. Vehicle 60 LIcense Plate rJo FuUO 61 State 61 E.p Yr I" PlateTvpe ~ 64 \lalue D .. Status PartlðlD 0 II: w 169 VIN .. .j 65. \leh. Yr 66 Ma~e 67 M'JO~I 68.Stvle GJ V ;: w ,.. I" 172 VehIcle Notes 0 70 Color{s) To"",,ed By ~ '0 n. ~')'.L·:'~·) , ŒJ I(ç ..~~ - ...c~,," 7"'0 ./; - /~ .. . P'..... -I:;> ŒJ ,...- . " c>' ::; ~·I /¿.(" /(;;>ç'C~/ ; n / //~ /'1,J,,-- '<: ) 1·~ .- <7 ..../< , .~ ,. - /~- / q:c .-/ / /-¿;'~ (, ,{. G ~, , -f 0'7 .....-:0 " , -~ "5 ~ ,- ..../J . ~ ~ ~.(~ ..-~ /<;/. 77 ~ / ,~'-.-.. :> ¿""""7~ n .? v , > ;>...... 0 r ~ ,... ..,.£ ¡," "=- r¿ /, [J ¡:: , .. '" .....:..<, j;'~'L r.../.... ,-/ /'" .L/.. ,¿:, /, n:: " .., _ _, ,'<" 0 II: ~ ~ I.?r.j ~".- <: ~ 07"'''' .. Z c,<-; u /" ....-: ~-- - ., ~- ,-..L" 'r~/ :;~..._ .7 ",' ø";:¡ .(. ~/~ /-?" ~/. , - r....q.-~ GJ /./, '~k L, J~ , ~ 74. Inqulrle'> (Check aU that apply) 75 NYSPIN M~~ge No 76 Complainant Signature B i ~ o DMV 0 Wal"tlWarran[ o Scotil~.... - OCrim. History o SlQlenProperty o Other -,- C theet . ,#Zicers.gnatur~r1 lB IDNo " Supervlsor's SIgnature (I"'clude Ra"'l<) I BO IDNo ! //. / (·Y. .' /:1' c ,-0/- J ~",^- " StCltU'> []~n ¡1~losed (Jf Closed. check boo below) o U...founded I;~'''~D;~ Þ ;> /83 No",..',70' ¡O, o Vict. Refu\ed to CoOP o Arre\t 0 p,O\ Ded....ed o Warrðnt AdvIsed OeBl o Ju" -No LUstod~ DAr":'~I.jUV o Offender Dead o E~tr~d Decl," LJUnk....OVIII" ~- ~'~-I-)J> S-32rJ5 (2,',? ~ I -FALSE STA TEMENTS ARE PUNISHABLE AS A CRIME. PURSUANT TO THE NEW YORK STATE PENAL LAW Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson r . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (630765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 30, 2002 Ms. Catherine Mesiano 12 Mill Pond Lane East Moriches, NY 11940-1222 RE: SCTM#57-1-20 MATINE, INC. 435 Albacore Drive Southold, NY Dear Ms. Mesiano: The following action as taken by the Board of Town Trustees during a Regular Meeting, held on May 22, 2002, regarding the above matter. WHEREAS, Catherine Mesiano, Inc. on behalf of MATINE INC. applied to the Southold Town Trustees for a pennit under the provisions of the Wetland Ordinance ofthe Town of Southold, application dated March I, 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 May 22, 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, WHEREAS, the structure complies with the standard set forth in Chapter 97-18 of the Southold Town Code. . 2 . 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 MATINE. INC. for a Wetland Permit for a single family dwelling on site septic system pervious driveway public water with the stipulation that there be a new non-disturbance area line be shown on a survey. 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. Ifinspections are required, at a fee of$5.00 per inspection (See attached schedule). FEES: $10.00 Very truly yours, a!/. L' ¡ ~ /~J::¿. çA./ Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC Building Department ~) . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hsll 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 ~IE ~ ~ U ~ IE ~ BOARD OF TOWN TRUSTEES 0 - U I TOWN OF SOUTHOLD IJ"A'( 2 5 200S So\\thold 10wn F,;)rd ·)t l¡lJs~Lee'3 APPLICATION FOR AN AMENDMENT TO So~r- L~P~(" ~(l)l~~ DATE tft 4- ( ¿;¿s: 2ev5 I' OWNER0"¡ ( I!OLD¡J/G- (. P , ADDRESS fJ ù, 80'f / 9" 25 PHONE 7 (; S- - t::2 ¿ () ------- S OU7 f{OL I) I/. '(: I L2 7 ! ~ AGENT PHONE ADDRESS PROPERTY LOCATION _£_J2~~~CcJA r.....- f)¡( f ___ TAX MAP NO. lOOt) )- 7 01 cd uwc :To f( ~ H U/C r Abu request an Amendment to Permit # b 0 S / I . /,vC LV ~ A lJélU --'Þ 'f 2-S- ¡I.<.íA-- ¡he K ~ SignedB?~ ÎM7¡t/(jYI. r OI,d '¡"- ul.~;p 51 0$ · , NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES. TOWN OF SOUTHOLD In the matter of applicant: :J~ C jIOLD/vG-S L. p, SCTM# /000- 57- 0/- 2 0 , YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Pennit from the Board of Trustees to: A/YI&AlD Pt:.fUV) (1 jf 60S! /0 jA/CLUDe;- A ¡t/t; u./ /blìZ~S' REAR (j(ÇC!-( 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 1-3S ALßArOf(£ DIl, 50U1/-1OLDj IJ 'j //97/ 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 ofthe Town Code is open to public comment on: W,¿ [), JV¡JL".JeJ J.)o5. You may contact the Trustees Office at 765-1892 or in writing. I The above-referenced proposal is under review of the Board of Trustees of the Town of South old and does not reference any other agency that might have to review same proposal. PHONE #: ¿,f. OWNERS NAME: J"" C MAILING ADDRESS: Enc: Copy of sketch or plan showing proposal for your convenience. .... , . . PROOF OF MAILING OF NOTICE ATI ACH -CERTIFIED MAIL RECEIPTS ftCOj/ Name: AMVA /r1At</A G- W¡V(;. -I "JOHAJ CApO/OSlO :JLI-I As50CiATeS LL C ) GAf'TI-IAtlOLf) «.~r;¿5E :J"¡ C floL()/1/{,5 L f / G-t..t:J..!µ f/U/)Tft1A,vV '. STATE OF NEW YORK COUNTY OF SUFFOLK Address: /;2.&, 5()uiJDiI/EvJ IO'?RACf! /ooo-S7-/-IJ".¡. J./o/t/I-I-PM ~ A/ /. /(76'v 1'1 PO. !30Y- 19,;1.5 /OO(J -5' '07-/<{- SOUJ7!Ül-O/IV."! /N71 7f vJ HI TE illI LL /2.oA 0 I ()ou - S7- / - II !<QC reV, LLC CC:I/TfÇf::' AIi' /1570 P.o. boY- l'lclS / /cou-S7-/-'I..!, sOUrµùLD/Ñ./. (/77) /7;2.5 AIJc/-IrJlI. LA¡J(Ç /CJo<J-51-/-21 Sòu7'I!OL.J)/ AI, /. 1/97/ :Jï)~¡J L /'¡uIl1AOù ,residingat 3't'où L../G+ll/-/ûusi! f/-uAI) S iJuUIOL () , Ai. Y. I{ tj7 / , being duly sworn, deposes and says that on the :).. daý of ,;J, b , 2CJQS:., deponent mailed a true copy ofthe Notice 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 ro1\ of the Town oC Southold; that said NOlices were mailed at the United States Post Office at .5 () v (flu'- I) , that said Notices were mailect to each of said persons by (certified) (Jrg II !.+) mail. Sworn to before me this ~ Dayof triA 1 , 20 D '~'''~Î1 ~ -l ,-- I/,rJI, ~ J "- Not Public BONNIE J. ooROSICI NoIary Public, Stale 01 "..'tilt No. 01006095328, SuffÐIk Couatr Tem Expilll JuIr 1, 2O..l4- YJ~<?~/ -----.. ~ L ,,/ ., "..-...- .. ~"JI:.Imf.'\ ~'-1 i'lr~...,. ~ CERTIFIED MAIL" RECEiPt ~ (Domeslic Mail Only; No Insurance Coverag¡, Provided) t:Q~~ïl7.. ...a.""!.·. ;---r.. 1" .... ~ I· " . ~ .~ ,~: U1 L _"_,--\;,(,,.-1;. :rf ~~",~ ....: 11 '" co I \ r=I postage'~ !J.n UNIT ID_:~'9.?,~l o C..rtlfiedFee o o ,--\ PO'l~, Ret"rr; Re.::,ept Feø 11 0, . Er,CJoS6,nentAe':¡'JJed)~ .'~ Her~ o ~"'5Trcl.dDell~6I)'Fee 5a-- Clet~: (W2JC~ r-=\ t:.nOOIS8 nenlReQulIElQI rl rn Total P"slagê & Foes $ 4.42 OS/2to/05 2.30 fTl o I SenlT(; _ J . // ¡2 ~i'¡~i·>.¡/io&···&··0:ç./-fl/dA{f)A/..._._,n.~n..._..- ~;:?s::';,~;~·{';:5·ð.·.¡~¿i~~_f/.;)¡1-Æ:.·j··_····_··- a- a- « fTl U.S. Postal Service", CERTIFIED MAIL,., RECEIPT (Domestic Mail Only; No Insl,Jrance Coverage Provided) «J ;5';L '" )O'~'- '.... r S()(!nIÜ; Nf"" ¡£ I A;:W Po".,. $ O.J7:' UNIT IÐ: ®11 8. CortlfiedFee I ',1,1. !6·'\Jj·, \--':'¡ o L. 2,30' i I o Relum Ra(";,epl Fee I I ~t{1'\,,"k. ~ :;;;;;';:;~:.;:~';'~; ~1' 75 'btè~"'K~?;4 TOlal Postage & Fees $ 4.42 OS/26/05 fTl °Fto ¡2 fs-:JJH IjS-:;'C!:jjs.I£5 {If) ~!?!!i:;;/~o.~ re' eO .( iy~ 7__ ~.m'h_...m'hn"nu._n. r CIf)', Slate. ZIP+4 ---. u...m_..n...._..6_. C- ! .. .. ... . ,-~, , "..~ ....-... . ,,,,,:r.mm 1-'t'-1'.¡ !íF-"., :g CERTIFIE ~AIL,,, RE(i:EIPT ~ (~d~:.C".&~,!.I,;'I'~.,¡¡'I·r'Jr¡;.r;r.~:J::r'Jr:~J ~....~-,.~ ...... ......-..-. ;: ... ¡::Q I ~.. .-, -....- . ::r ._".~" ~ -.. ! To ' Wl .Jvt...,;;...;.....,.'~, :: ,.ì· . -.. "" Postage 1$ 0.J1 - . UNIT [[I: 0"71 n o o o . r, . ·",\;":2:"!,Ó--·.('Y' " Pû~tm¡u'1< H"rd Certified Fee ,I Ret<Jm ~ec:leot Fee 1 iEndof5ementReq.."redJ Cler}··: KW2.JCl, c:J Restricted Delivery Fee I r=I ¡"Enoorsement ReqLJLredl I rl r'1 ___ q.1i2....._/ QS/26/05 Tolal Postage & Fees I $ r'1 g ,m a 'i C;l-o t' 'i2::5 'L T' r- Sfie-õCAiin:'¡ô~,:· -: :ï;:-·u -/-:)}....... m - n -.- --.~ - - - --- "POBa,No f" 80 ¡/ / 9;2 ~ ·ótY~ Stãtã:ziP:;.;¡::;n,n__mun._..nm.n..nu -.-. ul-( _....n__n···n_._ U.S. postal Service,,, '" CERTIFIED MAIL, RECEIPT ~ (Domestic Mail Only; No Insurance Cove~age _ Provlded) rn r';r.,..,ró,,,,,.,,,,,,,,,,,,,.,,..,,,,.,,,,. '"""'"",.............,,,~"",... ~ Q¡6fiIGslA\ USE '" «J J I N T Y - - Postage $ 0.37 UNlT m: 0971 . Certlfjed Fee 2.JCó> .- '. , .. .Poet:rnar1< RetufTI Aeclept Fee '~i"1¡5 Ho" (EmJOrsement ReQuiTðd) :-., ". Restricted Delivery Fee . .J, ~Ai . 6Cler1<: KII2JC4 (Endorsement Required) .,,}. Total posta.go & Fees $ '4.42J,~?ÚO~ n o o o o r'I r'I fTl ~ ~4N~:E.:0~-~·~~ffgu~~Yfflijlj-9 ë~:~;;Z1¡;;r:··:mT~--_n_uy~ //7 b I U.S. Postal Service" CERTIFIED MAIL RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) '" r'- <D fTl «J ::r '" <D " Po_ $ RoÐLicmri,Q LA.-k 0.3-1'{"/ r'I o o o Certified Fee Retum Røciept Fee (EnaorSQ/Itenl Required) CJ Restricted Dell..-ery F$9 ~ (Enaorsement Required) r'I fTl Total Postage & FØ$s fTl o o ['- '. , ?Mlf 1·;r.,,· . . ., 'APPLICANT/AGENTIREPRESENT A TIVE TRANSACTIONAL DISCLOSURE FORM The TO'"-11 of Southold's Code of Ethics orohibits conflicts of interest on the Dart arroW" officers and emoJovees. The ournose of this form is to oTOvide information which can alert the town ofnossihle conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: J ~ C. ).{(.,,_ D (¡vG-J L., p, (Last name, first name, J,11iddle initial, unless you are applying in the name of someone else Of other entity, such as a company. Ifso, indicate the other person's or company's name.) NAME OF APPUCA nON: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If''Other"-, name the activity.) Building Trustee Coastal Erosion Mooring Planning v Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest "Business interest" means a business, including a partnership, in \",-hich the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. / YES --- NO If you answered "YES'. omplete the balance of this form and date and sign where indicated. Name of person employed by Title or position of that person Describe the relationship between you ¡f(the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or The town officer or employee or his or her spou sibling, parent, or child is (check all that apply): _A) the owner of greater than 5% of the shares 0 (when the applicant is a corporation); _B) the legal or beneficial owner of any interest in anon applicant is not a corporation); _C) an officer, director, partner, or employee of the applicant; 0 _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Fonn TS I SubmittedlhisJ ~ day ~ ' 200--5 Signature ~' "::ed Æ.~ PrintNam ':JÒ'.'''' L-, tf¡)tf.-rA-i)Ù " .~ c "''--''-- ~o~ o~ A/-o/ ~"-. @ -S:~"'~~~~ A/( ~ . .~. 6'J'. ."~I-A-. ~ ~ / -!: ~c?3:' + -v .~<'..... ~ :':: o. ""'11:'- 4- ,;; Ui ~~ ~ ¡ f':!. r'\):-' G r? "' ~) Q ....' ¡;: \(' ~ i3 ~ ~ F: ~ ~ ~ .Cri ~ t n~ ~O~ . ~.~ @ TEST HOLE HCREON. WTH SAID LA W THE TERM 'AL TERED BY' ~) , ALL SURVEYORS UTlLlzr.lG A COPY AP. TERMS SUCH AS .,NSPECTED' AND ,. NOT "¡COMPLIANCE WITH THE: LAW. and cesspools field observalions led trom others. . ;. ~j -"~ . STANDARDS FOR APPROVAL OF SUBSURFACE: SEWAGE -=-OR SINGLE F AMIL Y REStDENCES 'nd/J/ons sel forfh Iherein and on Ihe "'. "' ''--,,---- ~ 9,s>. ; ARE REFERENCED TO JTHOLD SHORES . FILED 'LK COUNTY CLERK'S OFFICE 963 AS MAP NO, 3858 'o~ .@ .¡. '" ~.~. .J/ .Jt JÓ' 't ~, . ~~y ~./ \.y )/ / :t' .r }J¡ ... ¿., ,.,-, O~ FER' ~\ " . -~\ . LINE ~ HÆYI3ALE$ 'UMlTSpF CLEM¡JNG ( GRADING AN G~OUND Dl.Srv¡eð~NCE, - . ~ -1' ~ /. ..' / 'q' Q'" ,)". & ~r}-~~ ,,'" ,,-v\rìj J;.'t ~4'v "!~ ¥ ~ ~,,-~:l~'1 Q;'<; 'r,y'3r¡ ,.,~~'r #J'Ii v v t.~~iJ4&~rY v~~'" c,'.J 'r~c,O ~ . u F EL./J ~ . ~ .cr. ~ ~. Br.wn .t1IIdy I.... OL Br.wn fin. 10 _coar" . -lðtli/' - SW EL 5¡3' Will.,. /ñ /110"" /he I. co"'" .and SW /40'.... "' ~ ' ......... .. ......... . 'i. o d v l . Waler In brown cl.y SO· /'-:8 Waler In brown fin. 1o coa," sand SW " -<f(s 'A ~ CalL't. VÔ"(/c ...~ '~ ~..,)'->!',¡> ð.ð '---...... 4.- .s-)'--i! "'T'/v~ ~o~ ~ ~>!')'-/ J-c¿c @ ~. q,...., ~. ,.. , Ð..11 I ~) " /rPllOPOfTYLI£ 1."'/.......... 2~~ . '--------- LOr., 28 '/ ~. '--------- //.j HSE.~ ,.W..FLIf. ,a..J.1 £U2 Ih~ _ ~_ J·".,..1 LOT., 29 15% 2' 6.2' 7.0' CL 48' 54' -, ) . Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poli \\'oda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~"'1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TO\VN OF SOUTHOLD ----------~---------------------------------------------------- In the Matter of the Application of .;l!G-O 5/ ___~__~__~__~lcjl(~__I~J?______________________ COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, J Ò .( V ¿ ¡lUll' A{)Q residing at . 3%0 1--/ b-- IF¡vu'sG ¡t VA. D _..5"m!íff.o L D 1J.7. /(971 being duly swom, depose imd say: That on th~."day of !VIA 1. ' 200S. I personally posted the property known as _1-3> A.L-ðAC~JIl.. ')òu 1ffæ-O 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 public hearing. Date of hearing noted thereon to be held .Ji1JJ:!.. '</J '1Il.t 02'¡, ~ '" . , 0,., 011 ð u:t '1;(j Ph? Dated: ~/~ Sworn to before me this c?C::. day of /ltAt 2005 Dl ~ .~. l~l ~~\lIõLÞJ - Notary Public~_) 8OtIII1U DOROSJa llDIIIy Pubnc. St8II Of...1d 11o. 01006095328, SuIf8a ~ TIIIm ExpimJulr 7, 20~ Boarß of Trustees APplicatio~ ,. County of Suffolk :/I (,'0 ;; ( State of New York ,"lVI-I¡/" l. i-I¡)¡'I:(,I\(JJ of 54 C /-(()cO¡I-'CJ L f 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 WITH REVIEW OF THIS APPLICATION. ~/!5:L J--t C fjOLOII./G--S LP SWORN TO BEFORE ME THIS .JJe DAY OF IH.A/ ,diooS \\ ;Î'\L v ~ \/G'LG' \'- , Notar Public BONNIE 1. OOROSKI Notary Public. State Of New York NO.OID06095328,SUffOlk~J~~ij Term Expires July 7, 20 '\ 7 ., Town of South old . . . L WRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS I. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of South old Waterfront Consistency Review La\\'. Tllis assessment is intended to supplement other infonnation used by a Town of Southold agency in making a determination of consistency. *Excepl minor exempt actions including Building Permits and other ministerial pennils nOllocated withinlhe Coastal Erosion Hazard Area, 2, Before answering the questions in Section C, the preparer of this foml should revie\\' the exempt minor action list, policies and explanations of each policy contained in the TO\\1I of Southold Local Waterrront Re\'italization Program. A proposed action will be evaluated as to its significant beneficial and ad\'erse etTects upon the coastal area (which includes all of South old TOI\11). 3. If any question in Section C on tllis tonn is answered "yes", then the proposed action may affect the achievement of the L WRP policy standards and conditions contained in the consistency review law. Thus, the action should be analyzed in more detail and, if necessary, modified prior to making a detemlination that it is consistent to the maximum extent practicable with the L WRP policy sta.ndards and conditions. If an action cannot be certified as consistent with the L WRP policy standards and conditions. it shall not be undertaken. A copy of the L \VRP is available in the following places: online at the Town of South old's \\'ebsite (southoldtown.nonhfork.net), the Board of Trustees Office, the Phuming Department. all local libraries and the TOl\11 Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTl\f# /ODD - .)7 - D I - é). 0 The Application has been submitted to (check approptiate response): Town Board 0 l'lanning Dept. 0 Building Dept. 0 Board of Trustees B I. Category of Town of So nth old agency action (check approptiatc response): (a) Action undenaken directly by Town agency (e.g. capital construction, planning acti\'ity, agency regulation, land transaction) o o (b) Financial assistance (e.g. grant, loan, subsidy) (c) Pennit. approval, license. cenification: Œ(' Nature and extent of action: .¡¡. ,...oSI rù AIAl:!ul) Pø./Pf/r f;:>1 TéJ /l/ct..uD('.r ~ I , .u(JV./ /C )<~S RÇA;-~ Dé Ck Locationofaction: 'f-J5 ALßACol..G D/1..· Site acreage: / S <¡f?- .519.. F r I Present land use: /<. f SID G vT/ AC Present zoning classification: I<. CS I D ~ IJ 1/ A L.- SOU1f/ù'--~ AI'/. /)77/- , --- 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Nanleofapplicant:----=r coI C I-ID/...D/lJr-rS L, f. f. (), !30'¡( 19c25" Sou/I1CLD 1/. Y !!tj7/ /' ' (c) Telephone nWl1ber: Area Code () (;31/-':;33 - if 3/9 LIlA ( .Æ7íJ/; ::rO,lfu IIvll--ÍÁOD (b) Mailing address: (d) Application nWl1ber, if any: Will the action be prectly undet1aken, require funding, or approval by a state or federal agency? Yes 0 No 0 If yes, which state or federal agency? _________ DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Sonthold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See L WRP Section III - Policies; Page 2 for evaluation criteria. DYes 0 No ~ot Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See L WRP Section III - Policies P?es 3 through 6 for evaluation criteria DYes 0 No G1 Not Applicable Î Attach additional sheets If neees. . Policy 3. Enhance ,'isual quality and protect scenic resources throughout the Town of South old. See L WRP Section In - Policies Pages 6 through 7 for evaluation criteria DYes 0 No ~ot Applicable ---- ---------- --- ------ ------ --------- -------- --- Attach additional sheets if necessary NATURAL COAST POLICIES Polin' 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See L WRP Section III - Policie~es 8 through 16 for evaluation criteria DYes D No ~ Not Applicable -------------------- ------------------------------ -------------- -- --------------.~------------ ------ ---~--_.- -------------------- Attach additional sheets if nèce~,)ar~ Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - Policies Pages 16 t~h 21 for evaluation criteria DYes D No ~Not Applicable ------------------------------------------------~-- -------------------- -------------------- ------------------------------------------------- -------------------------- -------------------------- ------------- Attach additional sheers if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. DYes 0 No ~ot Applicable ----------------------------------------------------- ---------- ------------- ----------------- ) Attach additional sheels if necessary Policy 7. Protect and Improve air quality In the Town of Sonthold. See LWRP Section III - Policies Pages 32 through 34 f¡eValuatlon criteria. DYes 0 No [21 Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastey See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria. o Yes 0 No B Not Applicable -------------~--------------------------- ------------------------- --------------------- -------------------- PUBLIC COAST POI~ICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See L WRP Section III - Policies; Pages 38 through 46 for evaluation criteria. / o YesD No~ Not Applicable -~-------- ------------------- Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses I suitable locations. sre LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. DYes 0 No 0 Not Applicable -.... . . , . Attach additional sheets if neces~ary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. SeepVRP Section 111- Policies; Pages 57 through. 6Z for evaluation criteria. DYes 0 No []INot Applicable Attach additional sheets ifnecessary Policy 12. Protect agricultural lands in the Town of Southold. See L'VRP Section 111- Policies; Pages 6Z through 65 for eYalua)\pn criteria. DYes 0 No cr Not Applicable -~------------ ~---_._---- -------------~--------- ------ ----~---------------- ---- ------------------- ---------------------------- Attach additional sheets if uec..:ssary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section 111- Polícies;yages 65 through 68 for evaluation criteria. DYes 0 No [3 Not Applicable Created on 5/25'05 11:20 AM . Albert J. Krupski. President James King, Vice-President Anie Foster Ken Poli\.\'oda Peggy A. Dickerson ,,~~ r.~\,: en Z~ 'ð. ~ . ~ ~"t- ~J+9 . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone '-631ì 765-1892 Fax 1.6311 765-_!óCo'l1 BOARD OF TOWN TRUSTEE TOWN OF SOUTHOLD _Coastal Erosion Permit Application --Wetland Pe-mlit Application ~__ Administrative Perrnit AmendmentfT ransfer/Extension ----'~i\'ed Application:~U-LL$-B't vfGéeived fee:$ \'\)- _ -emnpleted Application I I o:¡ _Incomplete__ __SEQRA Classification: Typc l___Type U_Uruisted_ _Coordination:(date sent) ._ :...-eAC Referral Scnt:__i!1l!1J:!i'l ~e oflnspection:__-iJ:Jl2i.J1f-_ _Receipt ofCAC Report:__ . __lead Agency Detemlination:__ Technical Revie'w: ~¡¡blic Hearing Held: JJJJ(jj ò.'! __Resolution:______ Omce lise Only Name of Applicant__ 'V1.A Tt ¡J If / IJ C , / AddressJ 0. ßO'f. /'ídj (;3/ 7(.,)-61.2.0 Suffolk County Tax Map Number: 1000- NOV 1 9 2004 "'1liiio/(/_ loard 01 Tnø_ IIW - <-f 3 /9 Property Location: ~,3':; ALl3Á(OIl.t! 0;[..1 vr! Sou :íIl..OL-lJ 50uíI-!OLD. jJ, '/ / Phone Number:( ) r; 3/ 5 S:3 - 57 -1- 2.0 (provide LILCO Pole #, distance to cross streets, and location) . f AGENT: (If applicable) Address: ---- Phone: ------- $~~; . . Board of Trustees Application GENERAL DATA Land Area (in square feet): J~ 311,1(3 Area Zoning: p. - 'fO Previous use of property: _J)~C A ¡J í Intended use of property C6V,'i ¡flU (TfO¡'/ Or 5/1JrrL C f2pt I L/ _D lI./(" LL-fv v Prior permits/approvals for site improvements: Agency I'. ,D,~ ., Sou1HoL-D 8LD~. WJ --X/I;~-_~{)G-.:_f(Ql.1'f lí _DEe.. ,/,;J:J.)D'f 'TIDA.l.- wC!-TLÆµ1)5 , , (~()vll1{)i-01/l.v.l.TÇé"-S_ ~J~ '--/0 L.- ~ þ- 'f- f / Il (: 0 1t:~1'f I T W"(:ft 4""/)5 (lC7f-If( 7' _ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? -L No_ Yes If yes, provide explanation: ~ ( ( Project Description (use attachments if necessary): CoP 5 T/luc ÎI OJ...-' or t 2 )c S ¿ (( ILK r::~ G- ((:f FA;I( lLy (j II./(Ç I....L/,vC- -¡_/J t!. ;1./'/IOU 5 f)/lrU¿WAT AµI) ¡:JUbUc iJA-/á"- SU//"L Y (O.v SI;Ttf 5(;: (.<.lAG&' f)(S/ÓSAL SY-S7é'" /µçfAtú:/J ---Aµf2_/-0T lM-íL7 c UrAÆ.f/1) ) . . Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: -- Area of wetlands on lot: t l..ò 0 square feet ~ ~/o Percent coverage oflol: Closest distance between nearest existing structure and upland edge of wetlands: ¡///"A feet . Closest distance between nearest proposed structure and upland edge of wetlands: ¡{ (j feet Does the project involve excavation or filling? No / Yes ---- If yes, how much material will be excavated?_~ i cubic yards How much material will be filled? J//¡tit cubic yards Depth of which material will be removed or deposited: ¡/,þ feet Proposed slope throughout the area of operations: -4 5 j? ¡if (;' 5 (?VT L '/ f::-""' YIS / s Manner in which material will be removed or deposited: r-)< lAvA-/) I>,v A S:>vC (Af(-IJ W¡Tf-i h»Þ'DA/lv,v Statement of the effect, ¡fany, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments ifappropriate): ¡.Ie> S IG,I/ I ,c¡c A / T /I'tI'A cí /5.AIVT!cIPA.Tr¿{) As A ~('SUL.T òí- TfI& /,JiO¡J()56() ACT/(>,v: (I) EXIST/v&- 5E/'TIC 57'51/:"" 15 I1/Dl1.fÇ TIIAU /00';::1201'1 77../(f LU(CCTLA-t/[), (2-) ~II.D510f CotVíJ2.0L hlEAse/1( (;.$ 1/..11 L L ðc; TAKEµ' IJUt'<IVr".. CuI'" rlll/C" Jío'" /3 Y T¡¡(Ç U5€ Or 5TÃ¡(I3Ð IIAYßAL~5 (J) Dft.y ,.1(¿1(5 I}JIL.L 13£ jUt!;') I çD 1ì..~ r""nH7AII/ AJ/7 ),ZD¡v;t1U47~¡¿ R¡},voF¡:: GENf:fl-Aíe() ßì' THI.! /1'11'¡1.ovt;M(:A/75 ('I:.) A fJEtl..ViDVS DIlIU(5.k/Aý I¡JILL he; /Þ57ÁLL-(;O (:J)A 3D' jvol/-ÞISTU/I./jA(/C([ Bu¡:;.Fc;¡l.. AAJI) ~O 'PDI/-Tu¡¿F /3uF¡::Ut. IS ¡'J¡<OPò.5rfJ) /1/ 7/1(- ADJAC(;jLr1 AI<t:'"A . . ! 617.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL OUALlTY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT f SPONSOR 2. PROJECT NAME flll>J; u (¿ . ; pC 3.PRQJECT LOCATION f-35: ÀL8A(Ù.(L' D,-,t/C ,ÇurFoc--1<. Mun;clpallty ~"U 7¡;,,' L'" County 4_ PRECISE LOCATION" Street Addess and Road Intersections, Prominent landmarks ate . or provide map 11-35 ALBArO~l:! DIl I tJ(Ç (Su¡<II(}Y ÆTTAClIED) 5üvl(-/o( /) / Æ/ Y 5. IS PROPOSED ACTION 0 New D Expansion D Modification { alteration e y.. f¡ /¿ (" I) .5old TlfúUJ ~. ,,~. .,'~ .~ 6. DESCRIBE PROJECT BRIEFLY: r , "" ., , (bv 5 (II u C (;0'/ Ór- J;µG uP ¡:.A~/ L"7 Dil/P<L/PC. ( .5t:1'7fC !,L/51A¿u1J "1""0 .M7/',{OJtD) (LA.....~ /A,l7L y C lfA/lL'/)) 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTiNG ZONING OR OTHER RESTRICTIONS? GYes o No If no, describe briefly: ~AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) . ReSidential 0 Industrial D Commercial DAgriculture 0 Park I Forest I Open Space DOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL ~CY (Federal, State or Local) 5o(Jr"'o~D ði-D&, Yes 0 No If yes, list agency name and permit I approval: Iff ÁL 71' DEfT. DEe. "ßES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ¡, ç,¡, Yes DNa If yes, list agency name and permit I approval: 50VrHvt.-D ßL.OC-. f I o~. H"ÀL.T¡.¡ VëX (Jrd7/( it/S¡ALltQ-l ,A/'I'/!oll Sovr!40L{) 111(/570&'5 F'ff¡lI.tO De'.. (,/.;220,!- 12. AS A ~ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? DYes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant ¡ sp::or ~:L ~A1f:1:/f/µC Date /I/¡q/D'i Signature ~ 'tV If the action is a Coslal Area, and you are a slale agency, complete the Coastal Assessment Form before proceeding with this assessment . . Albert J. Krupski, President James King, Vice·President .Artie Foster Ken Poliwoda Pegg:.· 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of cö;;,~~~;~t~;-"'º'---~!'cfÆÁ1íp/"; STATE OF NEW YORK) /L/C _ AFFIDA VII OF POSTING I, "JU/-t¡/ L. 1--1 U¡l1,4V)ù , residing at --'I 35- 1- G, t3L1~ /725 A,:ß~CuÁu [)A ® _ .5J2 u II-( () '= 0 A/ L / / C¿ 7 / being duly sworn,~e and say: -1-1 That on theolb' day of NoV , 200<.1, I personally posted the property known as +-55" ALßÆCùrtif /JA. 5r)Uí/lol-1) frY 1/'l71 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 public hearing. Date of hearing noted thereon to be held /) ~t. ¿ cJ, 'Z- O()'T'- , , Dated: / "2 j; 7/0 t( ~Qð~j . re) .J-!- "- Sworn to before me this / -- day of þtr. 200 r.¡ TOH~ c. Hu~I4ØcJ ~~~~ N ry Public ~ John M. Judge NOTARY PUBLIC, State of New Y011c No. 01 JU6059400 Qualified In Suffolk County Commission Expires May 29,20 0, . . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Address: 7<f wl-/tícflA l-'- f1o~/) !<v<-KVlu(é cr¿-¡</r/l~ 1/1 1/5"7<.J /7,;;.5 AA/Cllù£.. /-.A,</<l' 5IJcJ(Ho/..../)/ ~y 1197/ jb~6I ¡!1A¡A/ !If), p,u Ooe>< ;</<;3 5N1lfo i.-I) / V 7· 11971 1';< G Sou.Þ~iJ(f:"</ Ie-(VAJC /o.!rJA-ffl"l'o/Ct; If// If76r f.e> 60)" /'12S 5Wíf.ro<...Ð; tV. 7. 11'171 Name: GAì-4-Hf'.(lOL-f) /I.(,:-~5¿ ((o<Ju -57-1-/)) &LGPA/ !-Ic'l)r;nAp ( /oc(r~7-/~21) V/vCCI/t:co... :U..t;AJ/), DoLoMITe: (/l")O -5G -()7-1'f) .Al/plA 1i14f1IA G-W(J./G-t JO"v C A l'oíuS To ((000-57-( -I(--fir) "J-I" c.. !/oLD¡ÞC--5 ¿ r ( lovoS7.. /.. 'I J) ST ATE OF NEW YORK COUNTY OF SUFFOLK :]'01-/£1 L-, HtJ/l7AÞo ,residing at 10 ðo;< /9';;'5 Sou7HvL./) N, '1. II '1 7/ , being duly sworn, deposes and says that on the .;2 (.., day of A/o v. , 20~, 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 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 South old; that said Notices were mailed at the United States Post Office at Sou 7/-fÙL V ,that said Notices were mailed to each of said persons by ~,rti'3' (re~"",,")m'iI YJkM I-It Sworn to before me this / ì - Day of Dt"í. ,20~ ~~t~~ John M. Judge NOTARY PUBLIC, State of N_ York No.01JU6059400 Qualified In Suffolk County Commission Expires May :29, 2O.2.J ~ ufl,v L H u µ.. r A(I(J () . . Board of Trustees Application County of Suffolk State of New York TO/lid L, /'¡v¡L7~\f)() 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 fITS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TfITS 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 WITH REVIEW OF THIS APPLICATION. " j.l-J,~ , C:·-:~ Signature SWORN TO BEFORE ME THIS /1:; DAY OF /-'0 (/ ,20 i.2..5f , ~~ JJ£~ ota '-- ublic --&Rift ~~"'~Q1 . . APPLICANT/AGENTIREPRESENT A TIVE TRANSACTIONAL DISCLOSURE FORM The To\o\'tl of South old's Code of Ethics nrohibits conflicts of interest on the Dart of town officers and emnlovees. The DUroose of this ronn is to orovide information which can alert the town of nos sible conflicts of interest and allow it to take whatever action is "eCe5SSf\' to avoid same. YOUR NAME: :---01-1 ¡tJ L. /-I U ILí.j\i) (.1 '\l!ast namè, first name, JJliddle initia!. unless you are applying in the name of someone else or other entity, such as a company. If so. indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If··Other"". name the activit)'.) Building Trustee Coastal Erosion Mooring Planning ,/ Do you personally (or through your company. spouse. sibling, parent. or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO ./ -_..- [fyou answered "YES'·, co lete the balance of this form and date and sign where indicated. Name of person employed by the Title or position of that person Describe the relationship between yourse (the applicant/agent/representative) and the town officer or employee. Either check the appropriate line A) through D) and/or de ribe in the space provided. The town officer or employee or his or her spouse, "bling, parent, or child is (check all that apply): _A) the owner of greater than 5% of the shares of e corporate stock of the applicant (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a no - applicant is not a corporation); _C) an officer, director, partner, or employee of the appLican _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this ~day of ~L/ 200 ::/ Signature . 0~ .. -^ Print Name - __ ) J (J 1-1 ¡V ¿ . /-/(..J ¡1. (- ~D (. .. . _,>"Z~)...'.:;..:;» ..'~'!>UffOl",,'" .\ . ~.ss.t'~" ;~ ~ '" . . cr... ~., ''ð ~: "If.. ~~: .~ ~~ . 't-~", ·_-'-·-:Z.:;,-,-·7~1 .. AJbprLJ. Krupski. President ·Ja!nes King, Vlce-PreBid~nt Henr;}" Smith Artie Fost~r Ken Poliworla Town Hn1 53095 j\fa.!n R ,:1'1 P.O. B'l'-': 1 !.'¡ Southold. Np·,\. y(,rk lJ g;! Telephone 15 J Û ~ ~'65-1 "'r2 Fti}( 1'51~'· iê-F-V~.n BOARD OF TOWN TRUSTEES TOWN OF SOl'THOLD 111/7 fT, I'ì 0 'S '\û.1ÀP5 Office Use Only I --Ltoastal Erosion Permit Applicarion v' Wetland Permit Application ---Grandfather Pcrmit Application ---waiver/Ãmendment~ch n~es ßece~'led Application: . !0'Ý Rece1ved Fee:$ M~~.~ Completed Application 2 Incomplete SEQRA Classification: Type I Type II Unlisted Coordination: (date s~~~" - CAe Referral Sent: ~ ¡ ~- -Dat;e of Inspection: ~/b v' Receipt of CAe Report: 7 Lead Agency Determination:-- Technical Review: I Public Hearing Held: 31Jvlû~ Resolution: I 1 I~~~ ~ L~ J-tc .: I.' Name of A~~nt (íì All tV E I tVc-. Address_r. 1;LG, ;¿;;~d. tV Ý 1/ c¡ 7 I I . (a 31 ~$3 -i/3J9 --_.~ Phon~ Number: ( ) Map Numter: 1000 - 57- ~:3r (t¿~ L1/}iH / / -2 c) k~·· . Suffolk County Tax property Location: (provide LILeO Pole #, distance to cross streets, 2l-- and location) :-1 \ {;tot;,.,. ~'- 1'<¡},.- AGENT: (If applicable )12 MILL POND LANE Address: Phone: FAX# : ------- . . . . MaTine Inc. 435 Albacore Drive, Southold SCTM# 1000-57-1-20 Name of Applicant: MaTine,Inc. Address: Box 1926, Southo1d, NY 11971 Phone Number: 756-6220 Suffolk County Tax Map Number: 1000-57-1-20 Property Location: 435 Albacore Drive, Southo1d PHONE/FAX: CATHERINE MESIANO,INC. 12 MILL POND LANE EAST MORICHES, NY 11940 (631) 878-8951 AGENT: 1 . . . . MaTine Inc. 435 Albacore Drive, Southold SCTM# 1000-57-1-20 Board of Trustees Application GENERAL DATA Land Area (in square feet): 18,811. 83 Area Zoning: R-40 Previous use of property: VACANT Intended use of property: CONSTRUCTION OF SINGLE FAMILY DWELLING Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description: CONSTRUCTION OF 62' X 52' (IRREG) SINGLE FAMILY DWELLING, ON-SITE SEWAGE DISPOSAL SYSTEM, PERVIOUS DRIVEWAY AND PUBLIC WATER SUPPLY. 2 . . . . . . MaTine Inc. 435 Albacore Dri1Æ1, Southold SCTM# 1000-57-1-20 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: 1200 square feet Percent coverage of lot: 6 % 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: 60 feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? APPROX 300 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: AS PRESENTLY EXISTS Manner in which material will be removed or deposited: EXCAVATION ASSOCIATED WITH FOUNDATION AND SEPTIC SYSTEM 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 SIGNIFICANT IMPACT IS ANTICIPATED AS A RESULT OF THE PROPOSED ACTION. · THE SEPTIC SYSTEM IS MORE THAN 100' FROM THE WETLAND. · EROSION CONTROL MEASURES WILL BE TAKEN DURING CONSTRUCTION BY THE USE OF STAKED HAYBALES · DRY WELLS WILL BE INSTALLED TO CONTAIN ANY STORMWATER RUNOFF GENERATED BY THE IMPROVEMENTS · A PERVIOUS DRIVEWAY WILL BE INSTALLED · A 30' NON-DISTURBANCE BUFFER AND 20' NON-TURF BUFFER IS PROPOSED IN THE ADJACENT AREA 3 SCTM' 1000-57-1-11 & SCTM # 1000-56-7- 14 Gay Reese 67 Eagle Chase Woodbury, NY 11797 SCTM# 1000-57-1-21 Gerald & Judith Salmon 149 Montrose Dr. Pt. Jefferson Sta., NY 11766 . - . SCTM # 1000-57-1-11 & SCTM # 1000-56-7- 14 Harold Reese 855 Sunrise Hwy, Lynbrook, 11563 SCTM# 1000-57-1-19 MaTine Inc. Box 1925 Southold, NY 11971 . SCTM# 1000-57-1-43 George Charles Kanuck 57 S. Bay Ave. Massapequa, NY 11758 , . BOARD OF TRUSTEES: TOWN OF SOUTHOLD In The Matter of the Application of MaTine. Inc. COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, Catherine Mesiano, residing at 12 Mill Pond Lane. East Moriches. NY being duly sworn, depose and say: That on the 10th day of March. 2002, I personally posted the property known as 435 ALBACORE DRIVE. SOUTH OLD SCTM # 1000-57-1-20 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 Public hearing. Date of hearing noted thereon to be held March 20 .2002. Dated: < Sworn to before me this ;Z'l day of ~ ,2002. ~- L0M- Notary Public JOYCE M. WILKINS NotAry Public. State of New York N~. 4952246. Suffolk County '~r"" Expires June 12. ~o3 NAME: . . PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS ADDRESS: . Gay Reese Harold Reese George Charles Kanuck Gerald & Judith Salmon MaTine Inc. 67 Eagle Chase, Woodbury, NY 11797 855 Sunrise Hwy, Lynbrook, 11563 57 S. Bay Ave. Massapequa, NY 11758 149 Montrose Dr. pt. Jefferson Sta., NY 11766 Box 1925 Southold, NY 11971 STATE OF NEW YORK COUNTY OF SUFFOLK CATHERINE MESIANO, residing at 12 Mill Pond Lane, East Moriches, NY being duly sworn, deposes and says that on the 1ih day of March, 2002, 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 Unites States Post Office at East Moriches, that said Notices were mailed to e,,' of ,,;d pe"',"' by œrtffied maH. (l ~ . ~" 1;rfj';' Sworn to before me this blY day of ~ ,2002. lD~" .,rW':Ë M. WilKINS Notary P'.úJ;¡c, StZitt: of New York No. 4952246. Suffolk Cou.P1Y Term ExpirnJune 12,. d,I..9<8 . . NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: NAME: MATINE, INC. YOU ARE HEREBY GIVEN NOTICE: SCTM # 1000-57-1-20 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: CONSTRUCT A 62' X 52' (IRREG.) SINGLE FAMILY DWELLING, ON-SITE SEWAGE DISPOSAL SYSTEM, PERVIOUS DRIVEWAY AND PUBLIC WATER SUPPLY. 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 435 ALBACORE DRIVE, SOUTH OLD 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 March 20, 2002. 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. OWNER'S NAME: MAILING ADDRESS: MaTine,lnc. Box 1925 Southold, NY 11971 OWNER'S AGENT: Catherine Mesiano, Inc. 12 Mill Pond Lane East Moriches, NY 11940 631-878-8951 Enc.: Copy of sketch or plan showing proposal for your convenience. l .. .. MaTine Inc. 435 Albacore Drive, Southold SCTM # 1000-57-1-20 Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: 1200 square feet Percent coverage of lot: 6 % 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: 60 feet Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? APPROX 300 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: AS PRESENTLY EXISTS Manner in which material will be removed or deposited: EXCAVATION ASSOCIATED WITH FOUNDATION AND SEPTIC SYSTEM 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 SIGNIFICANT IMPACT IS ANTICIPATED AS A RESULT OF THE PROPOSED ACTION. · THE SEPTIC SYSTEM IS MORE THAN 100' FROM THE WETLAND. · EROSION CONTROL MEASURES WILL BE TAKEN DURING CONSTRUCTION BY THE USE OF STAKED HAYBALES · DRY WELLS WILL BE INSTALLED TO CONTAIN ANY STORMWATER RUNOFF GENERATED BY THE IMPROVEMENTS · A PERVIOUS DRIVEWAY WILL BE INSTALLED · A 30' NON-DISTURBANCE BUFFER AND 20' NON-TURF BUFFER IS PROPOSED IN THE ADJACENT AREA 3 ~ .. . . MaTine Inc. 435 Albacore Dri,",. Southold SCTM# 1000-57-1-20 Name of Applicant: MaTine,Xnc. Address: Box 1926, Southo1d, NY 11971 Phone Number: 756-6220 Suffolk County Tax Map Number: 1000-57-1-20 Property Location: 435 Albacore Drive, Southold PHONE/FAX: CATHERINE MESIANO, INC. 12 MILL POND LANE EAST MORICHES, NY 11940 (631) 878-8951 AGENT: 1 l .. .. MaTine Inc. 435 Albacore Drive. SooIhold SCTM# 1000-57-1-20 Board of Trustees Application GENERAL DATA Land Area (in square feet) 18,811.83 Area Zoning: R-40 Previous use of property: VACANT Intended use of property: CONSTRUCTION OF SINGLE FAMILY DWELLING Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes If yes, provide explanation: Project Description: CONSTRUCTION OF 62' X 52' (IRREG) SINGLE FAMILY DWELLING, ON-SITE SEWAGE DISPOSAL SYSTEM, PERVIOUS DRIVEWAY AND PUBLIC WATER SUPPLY. 2 .. .. MaTine Inc. 435 Albacore Drive, Southold SCTM # 1000-57-1-20 County of Suffolk 1JJ'h, ~ ~ ßutcfl~ Christine Hurtado. President' ¡ .J/~~ ~ ;WORN DEPOSES AND AFFIRMS THAT SI ~L ABOVE DESCRIBED PERMIT AND THAT P 01 ..,1.. - ~_ IwN OARREK TRUE TO THE BEST OF HER KNO\ll -ð ~ WILL BE DONE IN THE MANNER SE- . -__/ -d A_A/' _ ~ I\S MAY BE APPROVED BY THE SOUTHC ~ J7~. THE APPLICANT AGREES TO HOLD n ~J TOWN TRUSTEES HARMLESS AND FREE I ~ . CLAIMS ARRISING UNDER OR BY VIRTLL. ~, _. .._ . rED. 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. State of New York Christiine Hurtado, President MaTine, Inc, SWORN TO BEFORE ME THIS DAY OF ,200_ Notary Public MaTine Inc. 435 Albacore Dm.,. Southold SCTM # 1000-57-1-20 .. .. STATE OF NEW YORK) 55: COUNTY OF SUFFOLK) CHRI5TIINE HURTADO being duly sworn, deposes and says: I reside at P.O. BOX 1926. SOUTHOLD. NY In the County of Suffolk and the State of New York. And I am the officer of the Corporation which is the owner in fee of the premises described in the foregoing applicatiDn and that I have authorized CATHERINE MESIANO, INC. to make the foregoing application as described herein. Christiine Hurtado, President MaTine, Inc. SWORN TO BEFORE ME THIS DAY OF ,200 Notary Public .. .. MaTine Inc. 435 Albacore Driw. SWlhold SCTM # 1000-57-' -20 APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics Drohibits conflicts of interest on the Dart: of town officers and emDlovees. The DUroose of this form is to Drovide information which can alert the town of DOssible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: CHRISTINE HURTADO NATURE OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of zone Approval of plat Exemption from plat or official map Other (If "Other," name the activity) Wetland Permit Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood. marriage. or business interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of (or employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO x If you answered "YES," complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself (the applicant) and the town officer or employee. Either check the appropriate line A) through D) and/or describe in the space provided. The town officer or employee or his or her spouse, sibling, parent or child is (check all that apply): _A) the owner of greater than 5% of the shares of the corporate stock of the applicant (when the applicant is a corporation); the legal or beneficial owner of any interest in a noncorporate entity (when the applicant is not a corporation); an officer, director, partner, or employee of the applicant; or the actual applicant. _B) _C) _D) DESCRIPTION OF RELATIONSHIP Submitted this day of 2002 Signature Print name CHRISTINE HURTADO , ANY AL TERA TION OR ADDITION TO THIS SURVE:Y IS A VIOLA TION OF SECTION 7209 OF THE: NE:W YORK STA TE: E:DUCA TION LAW. E:XCEPT AS PE:R SECTION 7209 . SUBDIVISION 2. ALL CE:RTlFlCA TIONS HE:RE:ON ARE VALID FOR THIS MAP AND COPlE:S THE:RE:OF ONL Y IF SAID MAP OR COPIE:S BE:AR THE IMPRESSED SE:AL OF THE: SURVE:YOR WHOSE: SIGNA TURE: APPE:ARS HE:RE:ON. ADDlTIONALL Y TO COMPL Y WITH SAID LA W THE: TE:RM 'AL TE:RED Y' MUST 8£ USED BY ANY AND ALL SURVE:YORS UTILIZPIG A COpy OF ANOTHE:R SURVE:YOlrS MAP. TERMS SUCH AS 'INSPE:CTE:D' AM 'BROUGHT . TO - DA TE' ARE: NO T IN COMPLIANCE: WITH THE: LA W. The localions 01 wells and cesspools shawn hereon are from field observalions and or from dolo obfained from of hers. '" Q '" ~Q ~Q =- Q= _0 ....go 2c;' ~" ~o ~ I am familiar wlfh Ihe STANDARDS FOR APPROVAL AND CONSTRUCTION OF SUBSURFACE SEWAGE DISPOSAL SYSTEMS FOR SINGLE FAMfL Y RESIDENCE and wl/l abide by Ihe conditions sel forlh Iherein and on Ih permit 10 conslrucl, !\¡ A/~~ 'A ~ COIL't. VÔ'(/C" ,.~ .....,?; ^ ~4..- <J~ $".~ 'YV.i' ~~". <.,- / NOTE' LOT NUMBERS ARE REFERENCED TO {O... , MAP OF SOUTHOLD SHORES ' FILED ,. ~ IN THE SUFFOLK COUNTY CLERK'S OFFICE ~ ON AUG. 29, f96:3 AS MAP NO. :3858 (0"\/ ~.~/ 'J' , " ~, ~~/.. ~~., ~~-/ " /', ~ / 4. / {if Q'" 0(/ ~~r!'~~ ,,'" ,.J;,r'ð v'tt;' ~.'v "j~,~CJ v (7 ¡¡''<-"""1- ~,,<$"" ~~¿y r ~~.'tþ\Ov ,Jf ~rf~·:rt\rI vVi<J0'Q '<~.J" à' 'Q~ ~ ~. . ,~ .cr- ~ ~. c~ ~~ <9, -- <;. --- . "8 " ,I LOT COVERAGE = 15% (OJ" " ~«.c«. @ '?'- ........ CER nqED "." J8C HOLDINGS', c'."'. COMMONWEAL -Lf L:J.V.') "C"!Ti.E WSURANCE ~/)MP.4·j ( SURVEY OF PROPERTY AT ARSHAMOMAQUE TOWN OF SOUTHOLD SUFFOLK COUNTY, N Y. 1000 - 57 - 01 - 20 SCALG 1" = 30' NOV. 28, 2001 MA Y 29, 2002 I cross see/ion , fH.) AUG. 9, 2002 Icer/ilication} SEPT. JO, 2002 I revisIon) Aug. 13, 200:3 (revlslO(ls) April i2, 2004' laddifions} "f~' G. zoo<¡' July 21, 200-4. (r"1v;s;ons) I.] / .1r"- ~. ':';' ._ i.-:. AREA = 18,812 sq. ft. SCDHS Ref. # RIO-02-0021 PfJLfI1ll' P J 0 5'7:3 C ~g ···l-···..· ¡;;:: ~ I'-' CJ .. . '" c c '-' l uJ --. ~OJ"' ~O~ C -<1-0/ @ ... .~~~-<1( -.. ó',-~. : 0,,8-, ~ :-S-¿>3: ."" -., .~C'..... ..p.. 0.. -rc:"- 4" '. if: '~--- -... 'I' -i- 'I- .i:" .J/ -l?: .JÓ' 'it ~ .-- OJ" ~ F E R'~ ~ ¡¡ ç; .. ~ ¡; ¡; .' . ~ }o. ~. [') ~ { ~ ¡ ro f'~ --! ;) ~~ \) ~ ¡; . ~ ; .. ~ ;;¡ -< ~ ~ f". ~ ~. ~ $Ii ~:to. ~u ~o '.".. c;. ~ '", @ TEST HOLE: ~ u 0,. T", '0'\ UNE O!= HÆ YI3Al ES "UI>1ITS OF C'.":A,~/NG ~'\ { GRIJDING ÆN G~OVND DISTV.Rð~NCE \ ~I ¡-rr; I fRofOSE-D 350 ¢ fT, _ I)DlllotJÆl-- wL,oD .!it-A De. 0< , CJ 0,ð ..../~.... ---::-:- 8rø",,~ /? 140'1- 1_ OL .",or: 9-" 2' ".0 Ç;( , ! Brown line ~.~~! I ¡,,_r;(lor" / sOlId SW 6.2' ëL 5,3' Wa'" In /In,,,, X IJne 10 coQl'se 0 s""d SW 7.0' rJ " l . . WaleI' In brøwn () clay \t!t3 CL \:~ r8> 48' Waler In brown c,' fine 10 coarse sand SW 54' VPROl'ERTYUE . " ", LOT #" 28 LOT #" 29 e/ //.-.3 HS£. ¡"'-'¡' FLR. . EU7 £LJæ , Ð..11 ¡ , /h_ /' E ,_ - 1":-'1 19.r 87 L ~u L,P"'~7. PROPOSED SEWAGE OISPOSAL , , 2' ..... SYS7ÐI 8 POOLs. 2' O£EP EL "-3---¡.L '10 ~ W/TH 3' a.E:AN SAND COLLAR Qt "~TERL.L.L ( 6' BELOW POOLS I~OO gø/. B~CKF1LL "If" / PRECAST éi5ìiëiil-ii SEPTIC CŒ.H....HO TANK. Boftöii"õFWCHNG TO CLEAN SA~ . ¡.. 8 POOLS TO BE: 2' ABOVE s" õt ~.,,1. GROlJNDWA TE:R CROSS EC TION SEPTIC SYSTEM " ~OJ" J.-'<.ç",- @ ~'" .P£COM (63fJ 76 765 - 1797 P. O. BOX 9 1230 TRA V£L£R STR££T SOUTHOLD, N. y, /1971 -.JI ___ I , I I ! . I I i I ,. ~ 1 - . ... ..~ , '. . ~ . j , J ¡ . ¡ , , 1 ~ , ~~~ . , ¡r¡i1~ "~;;t ~~Z M .~ ~o ~, ~V>;9 "'!;t~ Z " ~~g ~Hi::( ~~~ ~'"~ ~ o -.,., o""'0i: d -, '" "~" ""-E S ~=.:~ ~~ , Hal. ~~~o~ô~ ,~~~ ."^~ ~i~I!~~ ~;~~ ¡~;; ~~Ig~~~ ~~!~ ~~~ 't,,<;,..~ii~ ..,.-,~ zs; ~~§i'i~ ~~!~ ~i~ :iim: i~; ¡ol ~h:~ç ~. r ~ ~¡ ~. z 0 . v ~ g: I I ~ ~ ;1;- x ;o~ c 'i) , I ~D ;; ~ ':tI~ 0> I 1'1 ~ '= '" ~~ § ~ , Ó 'M ~ -~ ~ 0 8: i :p::.i v , 0 ~ ~ I ~ . i ;~i m'" ~~ ~ ~ ,<; '"' ~.:: .e, ~: v, c.. 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