HomeMy WebLinkAboutTR-5524 NOTICE •
Police Dept. - Bay Constable
Town of Southold
Peconic, New York 11958
NOTICE OF VIOLATION
Date:
To: PrUr! CONNOR
(Owner or authorized agent of owner)
Address: 3301 'JEEP iR)LE UR. MATTITUCK N.Y. 11952
(Address of owner or authorized agent of owner)
Please take notice there exists a violation of the Code of the Town of Southold, Chapter 97
Article II, Section 97-20 a premises hereinafter described in that a shad was placed apro..
Oft seaward in vi.olatioc of you, permiti!iasued by the Souyuld Town Rar:'rd oT Trustr,,U.
You are therefore directed and ordered to comply with the following: move thi, stied to the permitted
loom- ;on or •appSv for' an amench -ut to your er`niC to leave the shed its its location.
on or before the ;, day of �Wpgl. , 20__I .
The premises to which this Notice of Violation refers are situated at:
930 Deephole dr. -giattituck n.y.
'Town of Southold, Suffolk County, NY (Suffolk County Tax Map Designation: Dist. 1000
Section: 1 Block: 12 Lot: 12 )
Failure to comply with the applicable provisions of the law may constitute an offense punishable by fine
or imprisonment or both. NOTICE: You have the right to apply for a hearing before the Board of Trustees
of the Town of Southold, provided that you file a written request with the Clerk of the Trustees within 10
days after service of the Notice of Violation. Such request shall have annexed thereto a copy of the Notice
of Violation upon which a Hearing is requested and shall set forth the reasons why such notice of viola-
tion should be modified or rescinded.
Bay Constable, Town of Southold, NY
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DCJS-3205 (2/97) -FALSE STATEMENTS ARE PUNISHABLE AS A CRIME,PURSUANT TO THE NEW YORK STATE PENAL LAW.
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�� GG Town Hall, 53095 M
ELI7.ABETH A. pIGVII.LE �.Z` �L
TOWN CLERK 0 P.O. Box 117
yr Southold, New Yorl
REGISTRAR OF VITAL STATISTICS 0 _ Fax (516) 765-1
MARRIAGE OFFICER y O� ?- Telephone(516) 7E
RECORDS MANAGEMENT OFFICER
FREEDOM OF INFORMATION OFFICER -
OFFICE OF THE TOWN CLERK
TOWN OF SOUTHOLD
APPLICATION FOR PUBLIC ACCESS TO RECORDS
INSTRUCTIONS: Please complete Section I of this form and give to Town C
Office (agency Freedom of Information Officer) . One copy will be returned b
in response to your request, or as an interim response.
SECTION I.
TO:
(Department or Officer, if known, that has the information you are requestin
RECORD YOU WISH TO INSPECT: (Describe the record sought. If possible, s
date, file title, tax map number, and any other pertinent information.)
�,n- ✓L' `/ + 7 5 1- /G7 J J J L`- c T_ ✓ ��L'//L" 12,
Signature of Applicant: . t' _r—
Printed Name: S 1
Address:,f—� L=rz i �'ti �✓ �ei ✓9 7 2Z
Mailing Address (if different from above)
Telephone Number: z:55 6-S V Date: 3 - G - 6 Z
[ I APPROVED
[ l APPROVED WITH DELAY* [ I DEflIED
za a H A.' filflflfc-ce
Freedom of Information Officer
Saulffalirller
* If delayed or denied see reverse side for explanation. VAIrE2002
Southold Town Clerk
To: The Board of Trustees of Southold town
From: Constance Connor i
830 Deep Hole Drive, Mattituck
In regard to: Location of shed on property
I am sorry that I `m unable to attend this evening meeting. I have an engagement that I
could not change and my husband is out of town this evening however this is important to
us.
I will appreciate you reading my letter, with the consideration that a public forum is not a
comfortable environment for me nor do I care for confrontation.
Comments with regard to your visit:
I ask you please to look once again at my attached survey- While we have been
measuring from my neighbor's bulkhead my see that my property line extends past that
point. Does this make any difference with the distant from the waters edge? If we place
the shed as suggested 10' forward it truly does infringe on the cesspools and is roughly
12' from the comer of my home. You saw the builder stairs while you were here at my
home-I was hoping to do a landing with stairs across the back of the house on day. That
put the two structure close say even if the land was even 4 feet. Just something to
consider. 1#AJ`j
The original situation:
While I can appreciate my neighbor, Mary Edington, desiring a view of our creek from
her kitchen window-I must bring a few things to your attention.
I'm aware Mrs. Edington is upset at the height of the our house. Our house plans
consisted of the house being built at ground level, however, our builder failed to follow
these directions and built the foundation too high off the ground. Unfortunately, such
things were out of my control. I'm also sympathetic to my neighbors' loss of privacy
because the lot was vacant before we built and there was nothing but trees and over
growth. We had marked trees to be saved, but our builder was, once again, unsuccessful
in following the plan, and cleared the land. Since our move, Mary and my family have
been very friendly and I feel awful given that I can appreciate her position, age, length of
time living in the community and desire to have it all.
It's evident that the properties are narrow and we have a wider boarder on the right side
looking toward the house from the street so we thought this location would actually fulfill
our privacy issue not cover our cesspools and not to be intrusive to the waters edge. We
also intended to plant a border of shrubs, flowers, an ornamental tree on both sides of our
property to give back some privacy to our neighbors and us.
As for the shed, it is 8 x 12 (which is under the standard 100 square feet)*, ready built,
not a permanent structure which will hopefully sit on gravel that has been put down to
0 r
mark where the shed will be situated. Before all this I had spoken with the town-building
department with regard to placing this shed and no permit was necessary for structures
under 100 feet and that were not permanent.
After I had placed the gravel down Mary's son Jim approached me upset. At that time it
was clear that he would not hear of any compromise. Jim took me aback and his inability
to discuss the issue in a civil manner . I realized that I had to speak with Mary. At that
point I had cancelled the shed and it delivery until I spoke with Mary. I spoke with her
told her what I had done and it was clearly stated that I would talk to her in a week's time
to see how she felt. Two days later while I was at work the bay constable arrived at my
house and issued a summons for placing gravel down and we paid a two hundred dollar
fine.
I tried.
While her only issue is her view and not the shed I hope that there is some way to work
this out. I truly regret this situation and look forward to your input.
�,E'er � •��
Board Of Southold Town Trustees x
SOUTHOLD, NEW YORK
April' PERMIT NO. . �' .._ .._ . DATE: ....._A P...�.__..26...r....2002
PAUL & CONSTANCE CONNOR
ISSUED TO ..................._._.............._......_......................... _._.............
..............
'� .�l1lf'�ttl't�MftAlt
Pursuant to the provisions of Chapter 615 of the Laws of. I
the State of New York, 1893; and Chapter 404 of the Laws of the
State of New York 1952; and the Southold Town Ordinance en-
titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS
IN AND ON TOWN WATERS AND PUBLIC LANDS and the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS FROM
LANDS UNDER TOWN WATERS;•..) and in accordance with the
Resolution of The Board adopted at a meeting held on ...April 24.
200z:.., and in consideration of the sum of $....200.00 paid by
s Paul & Constance Connor
..............._. _....................._.._ _ _ _
.... ... ..........................................................................
2, of .._........Mat tituck _....._................................... N. Y. and subject to the
Terms and Conditions listed on the reverse side hereof,
of Southold Town Trustees authorizes and permits the following: s
Wetland Permit to construct an 8'X12'X10' shed, placed on
gravel, to be located no further seaward than the house
foundations on either side of the property.
all in accordance with the detailed specifications as presented in
the originating application.
IN WITNESS WHEREOF, The said Board of Trustees here-
by causes its Corporate Seal to be affixed, and these presents to
be subscribed by 'a majority of the said B`oaarr/d as of this date.
'/ZA
Ln
y
s
Trustees
TERMS and CONDITIONS
7be Permittee Paul & Constance Connor
residing at 830 Deep Hole Dr. , Mattituck N. y,, as
part' of the consideration for the issuance of the Permit does undetstand and prescribe to the fol-
lowing:
1. That the said Board of Ttaueea and the Town of Southold aft released from any and
all damage; or clakaas for damages, of oaks arising directly or indirectly as a result of any oper-
ation performed purmant to this permit, and the said Permittee will, at his or her own etgsenseq
defend any and all such adts*initlaoed by third parties, and the said promisee axumes roll liability
with respect thereto, to the complete a chtsion of the Baud of Tnettees of the Tom of Southold
2. That this Ferrol is valid for a period of 24 mo& whirs is aomideaed to be the
estimated time required to complete the wort involved, but should circumstances warnat, request
for an extension may be tide to the Board at a later date.
3. That this Permit should be retained indefinitely, or as long as the saki Permittee wishes
0o maimin the structure or project involved, to provide evidence to anyone concerned that anth-
otreadon was originally obtained.
+� 4. That the work involved will be subject to the inspection. and approval of the Board or
In agents, and non-compliance with.the provisions of the originating applkption, may be cause for
revocation of this Permit by resolution of the said Board.
5. That there will be no unreasonable interference with navigation as a result of the wort
hernia auidtoraed.
6. That there shall be no interference with the right of the public to pax and repass along
the beach between high and low water marks.
7. That if future operations of the Town of Southold require the,removal sad/or alterations
in the location of the work herela andwdud, or if, in the opinion of the Board of Trustees, the.
work shall cause unreasonable obstnscoon to free navigation, the said Fermi will be required,
upon doe notice, to remove or alter this Rork or project berein sated without espouses to the Towo
of Southold.
S. That the said Board will be notified by the Permittee of the completion.of the work or&
orited.
9. That the Permittee will obtain all other permits and consents that may be required sup-
plemental to this permit which may be subject to revoke upon failure to obtain same.
Albert J.Krupski,President • Town Hall
James King,Vice-President _p$VFFOit 53095 Route 25
Artie Foster �� h, P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A. Dickerson c Z Telephone(631) 765-1892
Oy �� Fax(631) 765-1366
�ypl � Sao
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
April 26, 2002
Mr. &Mrs. Paul Connor
830 Deep Hole Drive
Mattituck,NY 11952
RE: 830 Deep Hole Dr., Mattituck
SCTM#115-12-12
Dear Mr. &Mrs. Connor:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, April 24, 2002 regarding the above matter:
WHEREAS, PAUL & CONSTANCE CONNOR applied to the Southold Town Trustees for a
permit under the provisions of the Wetland Ordinance of the Town of Southold, application
dated February 25, 2002, 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
April 24, 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 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
NOW THEREFORE BE IT,
RESOLVED,that the Board of Trustees approve the application of PAUL & CONSTANCE
CONNOR to construct an 8'X 12'X 10' shed,placed on gravel, to be located no further seaward
than the house foundations on either side of the property.
BE IT FURTHER RESOLVED that this determination should not be considered a determination
made for any other Department or Agency,which may also have an application pending for the
same or similar project.
Permit to construct and complete project will expire two years from the date it is signed. Fees
must be paid, if applicable, and permit issued within six months of the date of this notification.
Two inspections are required and the Trustees are to be notified upon completion of said project.
Fees: None
Very truly yours,
Albert J. Krupski, Jr.
President, Board of Trustees
AJK/lms
S�F�atxc �'
Towrt Hall. SM5 plain Road
' P.O. Box 1179
Telephone O !� Southold. New York 11971
(631) 765-1892
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 Bret Hedges, seconded by Scott Hilary, it was
RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the
Wetland Permit Application of PAUL & CONSTANCE CONNOR to construct an 8'X
12'X 10' shed on existing gravel foundation.
Located: 830 Deephole Dr., Mattltuck. SCTM#115-12-12
Vote of Council: Ayes: All
Motion Carried
�gl1 ,�r a
Albert J. Krupaki, President FF01n Town Hall
James King,Vice-President `' lit" 53095 Route 25
Henry Smith P.O. Box 1179
Artie Poster
Southold, New York 11971-0959
Ken Poliwoda Telephone(631) 765-1892
Fax(631) 765.1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
June 6 , 2000
Mr. Peter Schembri
P.O. Box 163
Wading River, NY 11792
RE: DEEP HOLE DRIVE
SCTM#115-7.2--12
Dear Mr. Schembri. :
The Southold Town Board of Trustees reviewed the survey dated
June 24, 1995 and last revised November 29, 1996 and determined
that the construction of a single-family dwelling and deck to be
out of the Wetland jurisdiction, under Chapter 97 of the Town
Wetland Code .
However, any activity within 75 ' of the Wetland line would
require permits from this office.
This determination is not a determination from any other agency.
If you have any further questions, please do not hesitate to
call .
Sincerely,
Albert J . Krupski , Jr.
President, Board of Trustees
AJK/ims
NOTICE
Police Dept. - Bay Constable
Town of Southold
Peconic, New York 11958
NOTICE OF VIOLATION
Date: 'f :,-
To: Yaa; Jots;:,;r
(Owner or authorized agent of owner)
Address: n Df• •p lfoll , Dr. , 'Aat'tituck, N.Y, ; :1 ti
(Address of owner or authorized agent of owner)
Please take notice there exists a violation of the Code of the Town of Southold, Chapter 97
Article 1I, Section 97-20 a premises hereinafter described in that
activity within 1"M Feet uz a aetla*id witix+ut rst:
,i o;i� the ouctaol.d Town 'Tru:'tee ,.
You are therefore directed and ordered to comply with the following:
ac?'ivLty within I00 feet of wetlanda Apply for a ';Ya,atee Yei t for worlr.
alt—nay dope.
on or before the 28 day of z ebruiary , 20 0
The premises to which this Notice of Violation refers are situated at:
830 Oeep Ho-Le Dr. , ^iatticuck, N.Y. 11952
Town of Southold, Suffolk County, NY (Suffolk County'Pax Map Designation: Dist. 1000
Section: 17 5 Block: 12 Lot: 12 )
Failure to comply with the applicable provisions of the law may constitute an offense punishable by fine
or imprisonment or both. NOTICE: You have the right to apply for a hearing before the Board of Trustees
of the Town of Southold, provided that you file a written request with the Clerk of the Trustees within 10
days after service of the Notice of Violation. Such request shall have annexed thereto a copy of the Notice
of Violation upon which a Hearing is requested and shall set forth the reasons why such notice of viola-
tion should be modified or rescinded.
Bay Constable, Tbwn of South Id, NY
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Albert J.Krupski, President �Og C�C Town Hall
James King,Vice-President ��0 OGy 53095 Route 25
Henry Smith C P.O.Box 1179
Artie Foster cc x Southold,New York 11971-0959
Ken Poliwoda IS !�C Telephone(631) 765-1892
�01 �a0 Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only q111 FT .
_Coastal Erosion Permit Applications Shod �QC�
_Wetland Permit Application ✓Major _Minor
—Waiver/Amendment/ ha ges95
Received Application: y_Received Fee:$ -r•�`p
_Completed Application
_Incomplete
_SEQRA Classification:
Type I_Type II Unlisted
_Coordination:(date sent
_CAC Referral Sent: D tcu
_Date of Inspection: l/
_Receipt of CAC Report:
_Lead Agency Determination: t
_Technical Review:
_Public Hearing Held: o b
Resolution:
Name of Applicant C O U N O K i -PA-CAL-
Address 830 -DEEJPRo� 'E DR V
M RT0T1V.C.K Phone Number:( ) Z-qg- 53 91�
Suffolk County Tax Map Number: 1000 - `J - n2 - l-I-
Property Location: M T kCk- OA)N i s UTq()L..
inhakl e �O S ee *� g� 0
(provide LILCO Pole#, distance to cross sakets, and location)
AGENT: `
(If applicable) \�
Address:
Phone:
Board of Trustees Application
GENERAL DATA
Land Area(in square feet): / 01 4) 1 . 50
Area Zoning: 3 0�� 5 iccGl�fGs J
Previous use of property: / yA R
Intended use of property: :S E n f S"rU- A-C,G-
Prior permits/approvals for site improvements:
Agency Date
SahewAbri HOnLl ?P. Mf 2-OOc7
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:
Nev\/ 0M
Project Description(use attachments if necessary):
X lZ ' x 112, 1 (IO')
I�lac� shed
0n o ray e-1
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: S a u 2J
Area of wetlands on lot: 5 6 square feet
Percent coverage of lot: L 55 F %
Closest distance between crest existing structure and upland
edge of wetlands: I 10 W feet
Closest distance between nearest proposed structure and upland
edge of wetlands: PWb �d feet ^i o m t4 icy kW u'CEe,
Does the project involve excavation or filling?
oj
" No Yes
If yes, how much material will be excavated? A/ cubic yards
How much material will be filled? Y`F cubic yard#
Depth of which material will be removed or deposited: 2—
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
how, eowrer-
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):
NoN�
Board of Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity: S T-0 R A-G L=
Are wetlands present within 100 feet of the proposed activity?
No ✓ Yes
Does the project involve excavation or filling?
✓ No Yes
If Yes, how much material will be excavated? (cubic yards)
How much material will be filled? 0 (cubic yards)
a +a 7bl Lt cF,i S�
Manner in which material will be removed or deposited: bwnVllu '
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
b/0N� ke*- Ieve,1 "o✓c- 10
Albert J. Krupski,President ��$UFFO(,�c Town Hall
James King,Vice-President �.r� OGy .53095 Route 25
Henry Smith 0 P.O.Box 1179
Artie Foster NJ Z Southold,New York 11971-0959
Ken Poliwoda Oy !� Telephone(631) 765-1892
Fax(631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES : TOWN OF SOUTHOLD
-----------------------------------
In the Matter of the Application
of
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDAVIT OF POSTING I�
I 'COW'STAOCE (0 �j
JN0�, residing at D3D ) EE VWLE- p)�_
�-- "TiT-V _y, —k LW
being duly sworn, depose and say: I
That on the 4 day of H W 4, 20024 T ersonally posted t e
property known as CDNND� IZlS1D1 N�� (gam D £T�HOI �Dn
by placing the Board of Trustees official poster where it an
easily be seen, and that I have checked to be sure the poster
has remained in place for eight days prior to the date o the
public heari g. Date of hearing noted thereon to be held
Dated: ) .q-C) 2
(signature)
Sworn Sworn to before me this
day of ✓�#1.2cH 2O0a
V'C� 4 '16: k
Notary Public
UNDA B.BCHOU
NotrY NBWVxk
ft SUft of 0t
0"Mk wE*MaMM5 �.�ZC0L
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
-3OµN k osLosKl SeO D£eP i4aLe -De . MA-1-7 (TL. CK, fJy II�iSZ
7AME5 G-, INTON '780 D&F-P f-(oLE DrZ_ M4T-TirLkcK) NV
cA 20� ylU 1J R�I�t;T I (S D��Pj {v l� -De_ Vk TT► 1�c K, /
J-04 o
I ► q 58
STATE OF NEW YORK
COUNTY OF SUFFOLK �j
NWTAWL CONNd� residing at 83o pCt-P4pl-r-- pre-
V k being duly sworn, deposes and says that on the
z 5 day of F t,�> 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 Southold; that said Notices were mailed at the United States Post
Office at HABIT MA-(V, that said Notices were mailed to each of said persons by
(certified) (registered)mail.
Sworn tp efore me this ��
Day of �20o
Notary Public
HELENE D.HORNE
Notary Public.State of New York
No.4951364
Qualified in Suffolk County
Commission Expires May 22, ��
14-16-A(2187)—Text 12 '
PROJECT I.D. NUMBER 617.21 SEC
Appendix C
State Environmental Quality Review
SHORT ENVIRONMENTAL ASSESSMENT FORM
For UNLISTED ACTIONS Only
PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor)
1. APPLICANT(SPONSOR G 0 V h O R_ I 2 PROJECT NAME
0. PROJECT LOCATION:- VW ,^ cTvLT �l \CountY S / / r 0MuniclPalltY
4. PRECISE LOCATION(Street address and road intersections, prominent landmarks, etc., or provide map)
g3fl �"'i 4kOl -AP_ .
Nq-�rITtck , Ny `
5. IS PROP [IU
ED ACTION:
rr--�1
New Expansion Modificationialteration
6. DESCRIBE PROJECT BRIEFLY:
5kED 1—bR STO A-c2iE
7, AMOUNT OF AFF'cCTED: �
Initially a s 97 �a Ultimately RRS
6, VJIL' ROPOSEDDACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS?
L
Yes ❑No If No,describe briefly
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? 4
� Ike ?
,"Residential ❑.!ndusaial [:'Commercial Agriculture _i Park/FOrest/ODen space- 'Other
Describe:
reG i d e'W
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL,
STATLOCAU?
E0
Yes LJ No If yes. list agency(s) and permitlapprovals T r,
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
L'7-,Yes' ❑No if Yes,list agency name and permitlapproval
12. AS A RESULT OF OPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION?
❑Yes lNo
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant/sponsor e�:� Dale:
Signature:
If the action is in the Coastal Area, and you are a state acency, complete the
Coastal Assessment Farm before proceeding with this assessment
OVER
PART II—ENVIRCNiMENTA' 'Se-SMENT 70 be comcier.=_c by Agenc, ,
A Ob ES AC`CN -XCZED ANy ,. _i 7o RESHCU IN d NyCP.R. P;RT 517.:< If yes, ocrainate :ne review process and use ;r.e PUL_ Z�P.
_j vas !•vo
3. 'NIL'-ACTION RECEIVE CCCROINATED .RE`/IE'N AS PR.GAGED :CR UNLISTED ACT:CNS :N 3 NYCRR, PART 517.57 :f No, a negauve oectara
may he SVCersedec by anomer Involved agency.
I_yes ._;No
C. CCULD AC?iCN RESULT IN ANY ADVERSE E=RECTS ASSOCIATED'.VI TH -:-E :OILJWING::Answers .may oe landwnnen. '.f :egiblel
Cl. Existing air quality surface or'grounawaler Cualily or suantlty, noise Levels. ix:s:ing ::sit is aatterns. solid .wade gfocuc an or oisCc
potential tar erosion, ]ralnage Or ;locoing praclems?Explain nrierly: NO
C2. Aesthetic, agricultural, 3r➢naeological,hi Stark, or other narurai Jr cultural resources: or Community or nelgnoomood c,=actar? Explain J
ND
Cp. Vegetation or fauna. :13n. snellfisn or wildlife seecies, significant habitats,at :nreatened or endangered species? Explain orlally:
N0
C-. A community'S existing plans or goals as offlcativ spooled.or a cnange in use or intensity of use of land or other natural resources? Ezplaln or
IV
C5. Graven, suoseeuent 'eyelccment.or related ac:mties likely ID as induced by me
me Crcoosea aC.ion? Exotam cnefly.
'_erg :arm, ;nor; term.oumwative, or amer=Nets not identified in C,-CS? Exyam alerly.
No N�
-. Ctner Imoaas Zinc:,icing c.`.anges In ase of attner auantity, or:vpe at energy)? =:plain oneity.
NO Ni
J. S T}iERE.,--R iS'h Ei RE '_:KE_.' 70 BE. :::NTACVEaSY ?ELATED TC POTENTIAL,AE)VERSE ENVIRONMENTAL i.:PGCTS?
Yes 'Y`ro f"es. explain orieriy
?ART III-01F-j'cRMINATION OF SIGNIFICANCE (To he completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,(arge,important or otherwise signi tic.
"each affect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occa,-Wg; (c) duration'.
irreversibility: (el geographic scope: and (1) magnitude. If necessary, add attachments or reference supporting materials. Ensure
exolanalions contain sufffcfent detail to snow that all relevant adverse impacts have been identified and adequately addressed.
CheC:c ;his box ;f you have identified one or more potentially large or significant adverse impacts which MA?
- occur. Then proceed directly to :he FULL EAF anelor prepare a positive•declaraticn.
Chec:< this box f you have determined, based on the information and analvsis above and anv suoeortinc
cocumentancr:. :hat ;he proposed action WILL NOT result in_dny significant adverse environmental ;moac;-
AND provide on attachments as necessary, the reasons supporting this Determination:
j
v.•,,,e a _tau +.;envy
' .nm of ape �.me. y q•,pem:me•,;urcer m ,em •gene's line m [o�pommle Juicer
i
' Siena wre Or <rsaommm'�n&ar n _Ua igen<Y ixna:tire or lr�aare+ ;It _u:ereni :rum resoonvom oumrn
J„e
Board of Trustees Application
County of Suffolk
State of New York
CON% ofcE COO NC) -- 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
,O�F 'THIS APPLICATION.
Signature)
SWORN TO BEFORE ME THIS o'Z S DAY OF
Notary Public
:ENE D. HORNE
u-6:ic, State of New York
No. 4951364
,oalified in Suffolk County
= �asion Expires May 22, �10p -s