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HomeMy WebLinkAboutTR-6168 Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Bredemeyer Town Hall Annex 54375 Main Road P.O. BOx 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0709C Date December 7, 2011 THIS CERTIFIES that the single-family dwelling, deck, pervious driveway with drainage, sanitary system and 40' vegetated non-turf buffer At 2195 Edwards Lane, Orient Suffolk County Tax Map #18-3-6.12 Conforms to the application for Trustees Permit heretofore filed in this office Dated 6/28/05 pursuant to which Trustees Wetland Permit #6168 dated 7/20/05 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, pervious driveway with drainage, sanitary system and 40' vegetated non-turf buffer. The certificate is issued to ERNESTO ADRIANO owner of the Aforesaid property. Jill M. Doherty, President Bob Ghosio, Jr., Vice-President Jmnes F. King Dave Bergen John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box I 179 Southold, NY 11971 TelePhone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: V'/ Ch. 275 Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction ~ constructed V~Project complete, compliance inspection. INSPECTED BY: COMMENTS: Jill M Doherly, President Bob Ghosio, Jr., Vice-President James F King Dave Bergen John Bredemeyer PO Box 1179 Southold, NY 11971 Telephone (63 [ 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Meet with ERNEST ADRIANO to discuss compliance with Wetland Permit #6168, as issued on July 20, 2005. Located: 2195 Edward's Lane. Orient. SCTM18-3-6.12 awatrea t° be impacte~',~ er Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland P~act,~ha Town Code proposed work falls under: pt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment ~Ad ministrative__Emergency Pre-Submission __Violation Info needed: Modifications: Conditions: P, re.~ff Were: J. Doherty . Ghosio - ,J. r,.,ng __ V JBredemey~r D. Dzenkowski other Form filled out in the field by ~. Bergen, Mailed/Faxed to: Date: Jill M. Doherty, President Bob Ghosio, Jr., Vice-President James F. King Dave Bergen John Brcdemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: iCh. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ~ constructed ~'/Project complete, compliance inspection. CERTIFICATE OF COMPLIANCE: James F. FAng, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 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, haybaleline,l~/0~ - 1st day of construction ~'b~/~ . ~ ~Jtolo-~ov', ,~ ~~ Project complete, compliance inspection. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK SCTM~ 18-3-6.12 PERMIT NO.. ISSUED TO ut'l ri ati u Pursuant to the provisions of Chapter 615 of the Laws of the State of New Yor[, 1893; and Chapter 404 of the Laws of ~he State of New Yor~ 19521 and the Southold Town Ordinance titled ."REGULATIN~ AND THE PLAClNC~ OF OBSTRUCTIO. NS IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL OR OTHER tdATERIALS.F_JJ~OM LANDS UNDER TOWN WA'IT:RS;~.!. and in accordance with the Resolution of The Board adopted al- a meeti, g held o~ ...~.~?_..~.: .... .2~.~.~...., and in ¢onslderation of the sum cf $.....~?.t0.g ... paid by ~esto Adr ±~no of ............... ~.0.]~.~'.?.~ ............................. N. Y. end subject to the Terms and Conditions listed on the reverse ride hereof, of Southold Town' Trudees authorizes and permits the follow'mci: Wetland Permit to cons(rum a single-family dwe(ling, de¢~, pervious d~veve~y and sanitary system, wRh the conditions of ~he plan~ing of e 40' ~uffer from the road ~s per ~t'caohed planting plan, ~he placemem of h~y~ales along the road to pro~ect ~he weLland ~¢roes Edw~rd~ Lane, ~nd drainage for the driveway, ~11 as depicted on (he pl8n prepared by P~t T. L~nd Su~eyor, P.~. reoeNed August ~2, 2005. a~ in eocmdance wHh the deta~ s~cat~ns as p~nted IN WI~ESS WHERE', ~e said Board 0f T~tees ~re- by ~s ~ ~r~ate Seal te be a~xed, and ~ese ~[esenh be su~ed by a'maj~ of the s~id ~rd .es of this date. TERk4S and GONDmONS ~~ Ernesto Adriano 723 Greenbmlt Par..kway West, .Hgibrook. · ..... N. said ~loatd o~ T~ ~ ~e T~ ~ ~.~p~e ~ of ~ ~ ~ T~ ~ ~ T~ ~ ~d That tt~ Pe ~rmi~ should be ~ iadef'u~ely, or a~ fo~ ~ ~ ~ P~ ~ elxm'due flodee, to temo~'e or ~lter dds wo~ m project betda ~ ~1~ wMmut e~Eem~ ~o d~e ~m. Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Pegl~ A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 July 20, 2005 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Ernesto Adriano 723 Greenbelt Parkway West Holbrook, NY 11741 RE: 2195 EDWARDS LANE, ORIENT SCTM#18-3-6.12 Dear Mr. Adriano: The Board of Town Trustees took the following action during its regular meeting held on Wed., July 20, 2005 regarding the above matter: WHEREAS, ERNESTO ADRIANO applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated June 28, 2005 and, WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on July 20, 2005, 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, DCJS3205 12 q?l *FALSE STATEMENTS A. REPUNISHABLEASACRIME. PURSUANTTOTHENEW¥ORKSTATEPENALLAW Alber~ J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peg~, A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone ~631) 765-1892 Fax ~ 631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD BoardofTmsteesFieldI~pection Date Address Owner SCTM# Inspected by Findings. Photos taken April I3 Field Inspection From: Sent: To: Tetrault, Heather susan Antenen [santenen@tnc.org] Monday, May 02, 2005 3:55 PM Anthony Graves; Brian Frank; Charles DeQuilfeldt; Charlie Capp; Chris Pickerell; Craig William Kessler; David Berg; David Tonjes; DeWitt Davies; Dominick Ninivaggi; Enrico Nard@ne; George Bartunek; Tetrault, Heather; Jack Mattice; Jake Kritzer; Jeff Kassner; John Pavacic; Joseph Guarino; Karen Graulich; Kelly Hines; Kevin McAIlister; Klm Shaw; Larry Penny; Laura Bavaro; Terry, Mark; Marty Shea; Mary Dempsey; Mike Wasilco; Nick Gibbons; Patti Rafferty; Philip DeBlasi; Rick Balla; Stephanie Henrich; Steve Goodbred; Steve Python; Susan Antenen; Tom Iwanejko; Walter Dawydiak Subject: FW: Caged Fish Report Meeting Friday May 13,2005 ..... Original Hessage ..... From: Shaw, Klm [mailto:Kim. Shaw@suffolkcountyny.gov] ~ent: May 2, 2005 11:10 AM To: 'fecq@fecq.us'; 'lswanson@notes.cc.sunysb.edu'; 'fanders@dos.stat:e.ny.us'; dberg@cameronengineering. eom (dberg@cameronengineering.com); 'aesposito@citizenscampaign.org'; 'sanl:enen@tnc.org'; 'enache.adrian@epamail.epa.gov'; 'dmarkowski@vdci.net'; .lack Mattice (jmattice@notes.cc.sunysb.edu); 'dmildner@dos.st:ate.ny.us'; 'sreaven@notes.cc.sunysb.edu'; 'Karrie_Schwaab@fws.gov'; 'Craig Kessler'; 'mac@peconicbaykeeper. org'; 'wwise@notes.cc.sunysb.edu'; 'mdolan@citizenscampaign.org'; 'Jfullmer@citizenscampaign.org'; 'jkassner@ca-pc.com'; 'balla.richard@epa.gov'; 'gcapobia@dos.state.ny, us'; KAREN C (KAREN C); Charles deQuillfeldt (Charles deQuillfeldt); KAGRAUL[@GW. DEC:, STATE. NY. US (KAGRAUL[@GW.DEC.STATE.NY.US); .lohn' 'Pavacic (jwpavaci@gw.dec.state.ny.us) Subject.' FW: Caged Fish Report Meeting Friday Hay 13,2005 From: Shaw, Kim ~ent.' Monday, May 02, 2005 10:16 AM TO: Deering, Michael; Bender, Chades; Harper, Bdan; 13artha, Chades; Mitchel, Le,3lie; 'fecg@fecg.us'; '[swanson@notes.cc.sunysb.edu'; 'landers@dos.state.ny.us'; 'Cc:'; Kopf, Harion; 'aesposito@dtJzenscampaign.org'; 'Santenen@tnc.org'; Pr@los, George; 'Michael_Bilecki@nps.gov'; Davies, Dewitt; 'Enache. Adrian@epamail.epa.gov'; 'dmarkowski@vdd.net'; 'jack.mattice@stonybrook. edu'; 'dmildner@dos.state.ny.us'; 'Sreaven@notes.cc.sunysb. edu'; 'Kame_Schwaab@fws.gov'; 'Saterrac@usgs.gov'; 'michael.g.wssichelii@usace.army. mil'; 'wwise@eotes.cc. sunysb.edu'; 'ckessler@ducks.org'; 'mac@peconicbaykeeper.org'; Alden, Cameron; Bagg, 3ames; 'dberg@cameronengineering.com'; Binder, Allan; Bishop, David; Caracappo, Joseph; Caracciolo, Michael; Carpenter, Angle; Cooper, 2on; 'mdolan@citizenscampaign.org'; Foley, Bdan; 'Jfullmer@dfizenscampaign.org'; 'ggreene@ca-pc.com'; 'jkassner@ca-pc.com'; Kennedy, John; Lindsay, William; Losquadro, Daniel; Montano, Ricardo; Mystal, Elie; Nowick, LynneC; @'Leafy, Peter; Schneiderman, Jay; Tonna, Paul; 'Broadwinged@earthlink.net'; Viloda-Rsher, Vivian; Waters, Robert; 'bella.dchard@epa.gov'; 'bbiel@notes. cc.sunysb.edu'; Campbell, Scott; 'gcapobia@dos. state.ny, us'; 'knchytal@gw.dec.state.ny.us'; 'amcata@beilseoth.net'; 'AIlan.connell@ny.usda.gov'; 'dconover@notes.cc.sunysb.edu'; 'twc53@eol.com'; 'cxdequil@gw.dec.state.ny. us'; 'jdurda@integraJ-corp.com'; Gibbons, Nick; 'steveo.goedbred@sunysb.c-'du'; 'kagrauli@gw. dec.state.ny.us'; "Tom_halavik@Fws.gov'; 'Ech12@comell.edu'; HilJ, Kenneth; Hollborn, Rich; Isles, Tom; 'Nkk01@health.state.ny.us'; Kohn, Jennifer; 'gekozlow@gw. dec. state.ny, us'; LaVal[e, Richard; 'Mark_maghini@t'ws.gov'; McMahon, Thomas; 'Rsn0@cdc.gov'; 'vapeJmer@gw.dec.state.ny. us'; 'jposcucd@cameronengineering.com'; 'cpatterson@ducks.org'; Paul~en, Ronald; 'jwpevad@gw.dec.state.ny. us'; 'mshea@town.southampton.ny.us'; Sickles, WiJJiam; Slams, Fran; 'ds3@comell.edu'; 'lcsomersOca-pc. com'; 'Richard_Stavda[@nps.gov'; 'asvoboda@brookbeven.org'; 'Michelle_WilJiams@fws. gov'; 'amo03@health.state.ny. us'; ']zappier@dos.state.ny. us'; 'truesdaie.tracy@epamail.epa.gov'; Verberg, Ron; 'Hdam@optonline.net'; '(arus2~107@aol.oom'; 'smahar@auduben.org'; 'Research@neighborhood-net~vork. org'; 'Rtumer@southampton.Jiu.edu'; 'Auletta1@sachem.edu'; 'Bokina@optonline.com'; 'Bertelbruun@hamptons.com'; 'Sophiagarden@aol.com'; 'bcooke@audubon.org'; 'Devinney@optonline.net'; 'Brian@falconeJec.com'; 'LongJslaed@eart~save.org'; 'Mengland@audubon.org'; 'RgerTnero@optonline.net'; 'Gipc@optonline.net'; 'bay@friendsofthebay. org'; 'Ghuise@town.huntington.ny.us'; 'Akaliski@optooline.net'; 'ek72@comell.edu'; 'Coundl@estuary.cog.ny. us'; 'ga~y.lawton@oprhp.state.ny.us'; 'jim.matthews@nyu.edu'; 'Jnfo@harbormadna.com'; 'Lbettinash@notes.cc.sunysb.edu'; 'suffolk@neighborhood- network.org'; 'sepl4@comelt.edu'; 'we~tislipwibcc@aoLcom'; 'wjs$@cornell.edu'; 'edward.steppe@oprhp.state.ny.us'; ~rom_talbot@hotmaiLcom'; 'Gwalbrecht@citizenscampaign.org'; 'pjw@grassrootsinfo.org'; 'rsyelen@aol.com'; 'brian.zimmerman@ny. usda.gov'; Schlosser, Jeanine Subject: Caged Rsh Report M~eting Fdday May 13,2005 5/l 0/05 15; 2005 Field Ina~cfi6n Telephone (63 II 765-1892 To,va Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOVCN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., July 13, 2005, the following recommendation was made: ERNESTO ADRIANO to construct a single-family dwelling, deck, asphalt driveway, and sanitary system. Located: 2195 Edwards Lane, Orient. SCTM#18-3-6.12 The CAC did not make an inspection, therefore no recommendation was made. 56 Rose Way Water Mill, NY 11976 June 22, 2005 Southold Board of Trustees PO Box 1179 Southold, NY 11971 Re: Matter of Applicant - Ernesto A. Adriano SCTM # I000 SECI8 BLK3 Lot 6.12 To the Board of Trustees; ,~gt'hold ?m,m My name is Philip Sabalja, and I am the owner of the property on Edwards Lane, Orient, NY which is adjacent on the Southside (SCTM # 1000-18-3-6.13) of Mr. Adriano's property. I received the Notice on the Adjacent Property Owner which gives notice of Mr. Adriano's intention to request a permit from the Board of Trustees for land cleaming and proposed one family dwelling along with deck, asphalt driveway, septic tank and cesspool. I am writing this letter because I will be out of state through the rest of June until after Labor Day, and I want to state my concerns and views on the above-matter. I was appalled to see that the property was entirely cleared by Mr. Adriano. I fear that this clearing will cause soil runoffinto the wetlands area and the road since the elevations are 44 feet at the road and lower at the wetlands, and the footprint of his house is in the 58 to 60 foot elevations. Prior to this clearing there was heavy natural foliage of trees and underbrush which adequately contained any runoffonto the road and the wetlands. As a result of the clearing there will be excessive runoffof water, soil and fertilizers, "chemicals" into the wetlands. I request that the Trustees require Mr. Adriano to restore the landscape to both adequately protect the wetlands from runoffand to restore the harmonious picturesque, country lane landscape. I believe he should do this not oniy to the satisfaction of the Trustees but also to the satisfaction of the neighbors on the road. The survey which was sent to me showed an asphalt driveway which I believe should not be allowed because, again, it will facilitate runoffinto the wetlands. I also request that he reduce the surface area of his driveway. It is an unusually large driveway for a one family home. I also request that he reduce the size of the driveway's entrance which is now wider than 20 feet at the minimum width to a typical opening of 10 to 12 feet which is more appropriate to a rural residential area. The upper part of the driveway, prior to the parking area, should also be reduced to decrease the surface area to a more typical residential driveway. I request he put in a driveway made entirely of porous product rather than the asphalt driveway. Town of Southold ' 'A- 211 3 Suffolk County, NY 1~e People of ~he State o! New York vs. pA,~ KIN(:I SCN£DULED FINE~ CONTACT COURT [~ ~rI THE pER~ON DE~RISED ~ I$ SUMMONED TO ~ppEAR Al' COURT COPY TIMOTHY COFFEY AND/OR TIMOTHY COFFEY NURSERY/LANDSCAPE, INC. 44900 ROUTE 25, SOUTHOLD, NY 11971 (631) 765-2554 FAX (631) 765-2507 '~bur Eastern Long Island Landscape Specialist" Mr. Ernie Adriano Orient, NY 11957 DATE SUBJECT INVOICE 5/7/05 Work performed Machine Time Dump Fees BALANCE DUE $6500.00 576.00 $7076.00 We appreciate your business. Please sign the enclosed Certificate of Capital Improvement and return it to us with your payment. Thank you. NET 30 DAYS/OVERDUE ACCOUNTS - 11~% FINANCE CHARGE TIMOTHY COFFEY NURSERY/LANDSCAPE CONTRACTORS ~~ME.. ..... ...-. :.~.~ ...... TIME & MATERIAL SLIP OR\ ~ N~ ,~fi,~l~ A p,,qhq,,t/o 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 YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction Y= cen~r,,_cted ~u~e~- Project complete, compliance inspection. PLANNING BOARD MEM~IERS JERILYN B. WOODHOUSE Chair WILLIAM J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON PLANNING BOARD OFFICE TOWN OF SOUTHOLD MA[L/NG ADDRESS: P.O. Box 1179 Sou/hold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 ¢cor. Main Rd. & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 To: Town of Southold Board of Trustees From: Mark Terry, Senior Environmental Planner LWRP Coordinator July 13, 2005 Request for Permit for Emesto Adfiano SCTM#1000-18-3-6.12 Date: Re: The proposed action involves the construction of a single family residence, deck, asphalt driveway and sanitary system. A freshwater wetland system is located to the east of the subject property. The parcel is not served by public water and a private well will be required. The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form subnfitted 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 LWRP provided that the following standard best management practices are implemented. 1. Require erosion and sediment controls (haybales, silt fencing) to protect the wetland system to thc east of the properly. 2. Require water quality protection measures for areas generating runoff (gutters, downspouts, dry wells and pervious driveways) post constuction. In addition to further protect ground water quality and conserve water supply to the greatest extent possible it is recommended that the Board encourage the following best management practices for landscaping and lawn establishment post construction: 1. Require native landscaping to minimize irrigation and fertilizer applications. 2. Require disease-resistant and drought-tolerant plants (where possible). 3. Retain existing vegetation within non-disturbed buffers to minimize lawn areas~ Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Please contact me at (631) 765-1938 if you have any questions regarding the above. Albert d. Krupski, President James King, Vice-President .&rtie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Soul;hold, New York 11971-0959 Te ephone ~631) 765-1892 Fax (631) 765-~t~~] [ BOARD OF TOWN TRUSTEES TOV, rN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~etland Permit Application .A. mendme nt; Trans fer.'E x ten,on ~_M~'ece~; d Application: ~ompleted Application _~[ncomplete __SEQ'& Classification: Ts~e I~__F3pe Il Unlisted~ Coordioation:( dare sent) ~AC Refe~al Sent: _~te of Inspection: ~~ Receipt of CAC Report: Lead Agency Deter~nation: Tectmical Revie~: ~lic Hearing Hch~~ Administrative Permit JUN 2 8 2005 $outDo/d Town Bo3(d of Trustees /Z~a,'~) _/LI/.//, _//'~zq'/ Phone Number:~.~t) D(_TZ - Suffolk County Tax Map Number: 1000 - /~. 3, Property Location: (Or e. .Al. (provide LI.(,( 0 Po'~¢-#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ard of Trustees Applicat~on Land Area (in square feet): Area Zoning: 8'0 GENERAL DATA Previous use of property: Intended use of prope~ly:_O.) Prior permits/approvals for site improvements: Agency Date ',/ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? V' No Yes If yes, provide explanation: Project Description (use attachments if necessary): of Trustees Applica~n WETLAND/TRUSTEE LANDS APPLICATION DATA Area of`wetlands on lot: /0/~' square Percent coverage of` lot: ~/~ % Closest distance between nearest existing structure and upland edge of wetlands: /u/A feet Closest distance between nearest proposed structure and upland edge of wetlands: /~ feet Does the project involve excavation or filling? t~ No V" Yes If yes, how much material will be excavated? 2J5f cubic yards How much material will be filled? ~ ~ cubic yards Depth of which material will be removed or deposited: rf feet Proposed slope throughout the area of operations: ~:~ Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of'such proposed operations (use attachments if appropriate): ' .~3bert J. K~psl~, President James FAng, Vic~President .A.~/e Fosmr Ken Poliwoda Poff-A~ A, Diakar$on Town HaH 53095 Rout~ 28 P.O. Box 1179 S~m'~hold, New York 11971-0959 Telephone (6.71) 765-1892 Fs.x/6§I) BOAP, D OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUI'HOLD In the Maltcr of the Application of COUNTY OF SUFFOLK) STATI~ OF NEW YORK) AFFIDAVIT OF POSTING being duly sworn, depose and say: .~a~t o~n t~he /~ day ofr~_.~ ,~200k~[ personally post~ ~ property ~own a, by placing ~e Board of T~stees o~ci~ post~ write it can e~ily be sc~ ~d t~t I have checked ~ ~ sure ~e poster has ~amed in placebo[ erst days prior to the date of~e public being. Date of he~ng noted ~n to be held ~ ~ ~ ~. ~ -- ' ' ~ ~~ 9,'~ (si~mrc) ~S,~rn to b~£pre me ~his /g aayof~ 200~' ..' C/ U '- I£9 : OItDN'~(I 153~I*OON~N~33 617.20 SEQR PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. APPLICANT / SPONSOR 12~/~ROJECT NAME 3.PROJECT LOCATION, 4. PRECISE LOCATION: Street Addess and Road Intersections nt I or erowde mae 7. AMOUNT OF LAND AFFECTED: Initially ~ ~' acres Ultimately * ~'~'" acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~--I~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Chooseasmanyasapply.) [~Residenflal DJndustrial [~]Commercial ~'~]Agriculture DParklForestlOpenSpace DOther (describe) 10. DOES ACTION INVOLVE A PERMit APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal. State or Local) E~Yes ~'~No If yes. list agency name and permit / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? r~Yes j"~No If yes. list agency name and permit / approval. , CERT,F¥ T.AT T.E ~NFORMAT,ON PROVIDED ABOVE ,S TRUE TO T.E B~ST Of MY XNOWLEDG~ Applicant / Sponsor Name ~'~$~'~ /~ /~';~ Date: If the action is a Costal Area. and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment U.S. Postal Service, CERTIFIED MAIL, RECEIPT (Domestic Mall Only: No Insurance Coverage Provided) mmm' ......... · .............. J .................. ...,. ,~. ,,.~., ..,,,~..., ~ ~ ..... !1_ o,~F'.,ls~ I.A.L .U S E a ~ 0,3? UNIT ID: 07~1 Clerk: I~FX0 2.67 06/15/05 · - ~A~Z C" ................................................................... I'~':'~:'Z~'~,~,~r', ................................... ,~. V- 7J'?~ 7 ............................ ii~.~L,L[ ............. I / / ......................... ~,,, U.S. Postal Service. F~ CERTIFIED MAIL RECEIPT !I ~Q~F~,.I)'[,CIAL USE I , $ 2.67 UNIT II): 0741 Clerk~ ~B4FKO 06115105 U.S. Postal Service,, CERTIFIED MAIL,, RECEIPT (Domestic Mail Only: No Insurance Coverage Provided) ,~li~ EL~-~i ..~! I L USE 0.3? 2.30 2.67 UNIT ID: ~741 Clerk: TB4FKO 06/15/05 U.S. Postal Servic, ~' CERTIFIED MAIL,r, RECEIPT rU (Domestic Mail Only; NO Insurance Coverage Provided) (E~or~,ment Required) 0.37 UNIT Il): 07~1 Clerk: TI~q( 0 2.67 06/15/05 ***** WELCOME TO ***** HOLaROOK MPO HOLBROOK, NY 11741-2720 08/15/05 12:44PM Store USPS Frans 55 Wkstn sysSOO2 Cashier TB4FKO Cashier's Name ARLENE Stock Unit Id WINDARLENE PO Phone Number 1800AS~USPS USPS ~ 3548330741 1, First Class, 2,67 Destination. 11957 Neight: 0.50 oz, ~o~ge Type: PVI mral Cost: 2.67 Base Rate: 0.37 SEEVICES Certified Mail 2,30 70040750000187880324 2. First Class 2,67 Destination: 11944 Neight: 0.60 oz, ~ostage Type: PVI ~ota) Cost: 2.87 Base Rate: 0,37 SERVICES Certified Mail 2,30 70040750000187660317 3. First Class. 2.67 Destination. 11978 ~ei~ht: _ , 0.60 oz. ~ostage )ype. P¥I Total Cost: 2,67 Base Rate: 0.37 SERVICES Certified Nail 2.30 70040750000167860300 4. First Class 2.67 Destination: 11957 Weight: 0,80 oz. Postage Type: PVI Total Cost: 2.67 Base Rate: 0.37 SERVICES Certified Mail 2.30 70040750000157660294 Subtotal 10,88 Tote) 10.68 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED I~LAIL RECEIPTS Address: STATE OF NEW YORK COUNTY OF SUFFOLK ~cC~_~o7-e ,'~./~dr,~,,o , residing at 725 ~'vee,tbe(-/' ~l.O~j ~. I~L~~.~, ItTq/ , being duly sworn, deposes and says that ~n the 15th day of June ,20 05, deponent mailed a tree copy of the Notice set fo~h in the Bo~d of Trustees Application, directed to each of ~e above n~ed persons at the addresses set opposite there respective nines; that the addresses set opposite the names of said persons ~e the ad&ess of said persons as sho~ on the cu~ent ~sessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office at /~ ~oo~ , that s~d Notices were mailed to each of said pemons by (ceaified] (registered) mail. Sworn to before me tiffs Dayof June ,20 of Trustees Application County of Suffolk State of New York d /? do t~'~ /~ A d~- t ~ ,rl D BEINGDULYSWORN DEPOSES AND AFFIRMS THAT HE/SHE IS TH~ 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 TI-IF 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. Signature SWORN TO BEFORE ME THIS ~Nota~ Public~'~ KIERAN M. CORCORAN Notary Public, State of New York No, 02C06 1198~8 Qualified in Suffolk Ceunty _/ Commission Expires 0ecember 6, 20 0__~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The To'a~n of $Outhold'$ Code of Ethics prohibits conflict~ of interest on the part of town officers and emnlovees. The vurpose of this form i~ to provide information which ean alert the town of possible conflicts, of interest and allow it to take whatever action is necessary to avoid same, (Last name, first name,.middle initial, unless you are applying in the name o£ 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 Building Variance Trustee Change of Zor~e Coastal Ecosinn Approval of plat Mooriug Exemption from plat or official map Planning ((~tfh-,~t~er". name the acrivity. ) c~u. d.' Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee oftbe Town of Soathold? "Relationship" includes by blood, nlarriage, or business interest. "Basiness 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 V 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 thai person Describe the relationship between yourself(the applicanffagentJrepresentative) 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 groater than 5% of the shares of the corporate stock of the applic0nt (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); __.C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this Signaturo Print Name day of 200 .LWRP CONSISTENCY ~_~SESSMENT FORM ~ J~ 2 ? ~ INSTRUCTIONS 1. All applic~ts for pe~* including Town of Southold agencies, ~1 com$~h~ for propos~ actions that are subj~t to ~e Town ofSouthold Water~ont Consistency Review Law. I ms ~sessment is intended to supplement other i~o~ation us~ by a Town of Southold agency in m~g a detestation of comistency. *Except minor ~empt actions including Building Perm#s and other ministerial pennita not located within the Coastal Erosion H~ard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Tox~xt of Southold Local Waterfront Revitalization Program. A proposed action xx411 be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes", then the proposed action ma)' affect the aclfievement of the Lg?P,P policy standards and conditions contained in the consistency review law. Thus, the action should be atmlyzed in more detail and, if necessaD,, modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the Lx,~2EP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Toxxm Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION The Application has been submitted to (check appropriate response): Town Board ['--] Planning Dept. [---] Building Dept. [-~ BoardofTrustees ~ Category of Town of Southold agency action (check appropriate response): (a) Action tmdertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action~' If an application for the proposed action has been filed with the Town of Southold agency, the following information shall b~ provided: (a) Nameofapplicant:~ ~-¢r, tg~% /42)Rl~3J0 (b) Mailing address: 7;2,-3 ~/0~/,J6~I~""/LJ~.dJ (c) Telephone number: Area Code ,¢~ ~7,,,~ - ~?~a° (d) Application number, if any:. Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes ~ No [~ If yes, which state or federal agency7 DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances comnmnity character, preserves ope0 space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See L~zRP Section III - Policies; Page 2 for evaluation criteria. ~Yes ~-~ 1No ~Z~NotApplieable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Sonthold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [] Yes [~ No ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~-~ Yes [-~ No [~ Not Applicable Attach additional sheets if necessar3 NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Sectiott lll- Policies Pages 8 through 16 for evaluation criteria ~-~ Yes [~ No [~ Not Applicable Attach additional sheets if necessar5 Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III -Policies Pages 16 through 21 for evaluation criteria ~ Yes ~ No ~Not Applicable Attach additional sheets 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. ~-~ Yes [-~ No[~ Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section IH - Policies Pages 32 through 34 for evaluation criteria. [] Yes ~ No~] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southolfl from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. ~'~ Yes ~-~ No ~-] Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. ~] Yes ~-~ No [~ Not Applicable A~ach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III - Policies; Pages 47 through 56 for evaluation criteria. [] Yes [] No [~ Not Applicable SURVEY OF D£SCN/££D PR©P£~D~ S/TUATE AT ORIENT TOWN OF SOUTHOLD SUFFOLK COUAIT~, NEW YORK RLE NO. 504~ CERrIFIEO tO: PAT ~ SECCAFICO PROFESSIONAL ~ND SURV~OR, P.C. APPROVED BY BOARD Or TOWN OF SOUTHOLD .... ~/~ s~