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Home My WebLink AboutTR-5958 James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, If. 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 CERTIFICATE OF COMPLIANCE # 0170C Date November 21. 2006 THIS CERTIFIES that the garage, driveway, and sanitary system At 435 Beachwood Rd., Cutchogue Suffolk County Tax Map # 116-4-24 Conforms to the application for a Trustees Permit heretofore filed in this office Dated 6/25/04 pursuant to which Trustees Permit # 5958 Dated 7/21/04 and amended on March 23, 2005 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 garage, driyewav and sanitary svstem. The certificate is issued to WILLIAM & DIANE BEARDSLEE owner of the aforesaid property. r~7 Authorized Signature ,.,. 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. f:y e "'- r-d s j.e e INSPECTION SCHEDULE Pre-construction, hay bale line 151 day of construction _ Yo constructed ~Projectcomplete, compliance inspection. liJz.%lt. ok j-~ 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 March 23, 2005 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD William and Diane Beardslee 5 Ferncote Lane Brookville, NY 11545 RE: 435 BEACHWOOD ROAD, CUTCHOGUE SCTM# 1'16-4.24 Dear Mr. And Mrs. Beardslee: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, March 23, 2005: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit # 5958 to upgrade the existing septic system as per plan received March 1, 2005 by the Board of Trustees. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, Albert J. Krupski, Jr. President, Board of Trustees AJK:hct 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., March 15, 2005, the following recommendation was made: Moved by Jack McGreevy, seconded by Don Wilder, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Amendment application of WI ,L. LIAM & DIANE BEARDSLEE to Amend Permit #5958 to upgrade the existing septic system. Located: 435 Beachwood Rd., Cutchogue. SCTM#116-4-24 Vote of Council: Ayes: All Motion Carried Albert J. Krupski, President James King, Vice-President Artle 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 Pre-construction, hay bale line 1st day of construction % constructed ..~Project complete, compliance inspection. Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO ~'~... DATE: ....3..~]Y...~.~:.,.....~.904 WILLIAM & DIANE BEARDSLEE ISSUED TO ............................................ ~ ................................................................................... Pursuant to the providons of Chapter 615 of the Laws of the State of New York, 1893; and G~apfer 404 of the ~ws of the · Sta'fe of New York 1952; and the Southold To~rn Ordinance titled ."REGULATING AND .THE PLACING OF OBSTRUC~ ~NS IN AND ON TOWN WATERS AND PUBUC LANDS and-the REMOVAL OF SAND, GRAVELOR OTHER MATERIALS.~K4 LANDS .UNDER TOWN WATERS;~.~. and in accordance wdh 'the Resolution of 1t~e Board adopted at a meeting held - ~Tulv Zl, ;~.0..0..af., and in consideration of the sum of $....~.0..:...0.~ ...... paid by William & Diane Beardslee .. of ......... ~:.t..~.~..o.g...u...e.. .................. i ............................ N. Y. end subject to the Terms and Oondltlo~s listed on the reverse ride .hereof, of SouthoJd Town' Trudees authorizes and perm. tis the following: Wetland Permit to raise the existing g~rage; resurface the existing driveway with pervious gravel; replace existing sanitary system with new, Suffolk C;o. Dept. of Heath Services - confolming sanitery system to be elevated above groundwater by approx. 355 cy. of fill and concrete retmning w~ll; and ~onstruol access steps over raised septic, and ~1 as depicted on the su~ey prepared by Joseph A, Ingegno last deled June ~4, 2004. all in accordance with the dutaiJed spedficetlo~s as presented in · the odglnefing epplic~fioe. IN WITNESS WHEREOF, The ~ld Boerd bf Trustees ~re- by causes ifs Corporate Seal fo be afrhced, an~ these..l~esent's fo b~ subscribed by ~a'majodJy of the sald Board .as of' this darn. Ken Poliw6da 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 July 21,2004 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Mr. Robert E. Herrmann En-Consultants, Inc. 1319 North Sea Rd. Southampton, NY 11968 RE: WILLIAM & DIANE BEARDSLEE 435 BEACHWOOD RD., CUTCHOGUE SCTM#116-4-24 Dear Mr. Herrmann: The Board of Town Trustees took the following action during its regular meeting held on Thursday, July 21,2004 regarding the above matter: WHEREAS, En-Consultants, Inc. on behalf of WILLIAM & DIANE BEARDSLEE 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 25, 2004, 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 21,2004, 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, NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of WILLIAM & DIANE BEARDSLEE to raise the existing garage; resurface the existing driveway with pervious gravel; replace existing sanitary system with new, Suffolk Co. Dept. of Heath Services - conforming sanitary system to be elevated 2' above groundwater by approx. 355 cy. of fill and concrete retaining wall; and construct access steps over raised septic, and all as depicted on the survey prepared by Joseph A. Ingegno last dated June 14, 2004. 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.) Fees: $50.00 Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/Ims 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 Please be advised that your application dated reviewed by this Board at the regular meeting following action was taken: has been and the _~) 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: TOTAL FEES DUE: $ b~C), OO SIGNED: PRESIDENT, BOARD OF TRUSTEES 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 Tuesday, July 13, 2004, the following recommendation was made: Moved by Doris McGreevy, seconded by Bill Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Permit application of WILLIAM & DIANE BEARDSLEE to raise the existing garage; resurface the existing driveway with pervious gravel; replace existing sanitary system with new, Suffolk Co. Dept. of Health Services - conforming sanitary system to be elevated 2' above groundwater by approx. 355 cy. of fill and concrete retaining wall; and construct access steps over raised septic. Located: 435 Beachwood Rd., Cutchogue. SCTM#116-4-24 Vote of Council: Ayes: All Motion Carried DIANE AND WILLIAM BEARDSLEE, 435 BEACHWOOD ROAD, MATTITUCK Figure 3. Looking south across Beachwood Road at ext~ting dwelling and garage to be raised. Figure 4. Looking north from Great Peeonie Bay at existing house to be raised and altered. DIANE AND WILLIAM BEARDSI,EE, 435 BEAClt'WOOD ROAD, M~TTITUCK Figure 1. Looking west along Beachwood Roaa[ Note subject property and garage to be lifted to left and tidal wetlands associated with Halls Creek to righ~ Figure 2. Looking north from subject property at tidal wetlands located north t~'Beach wood Road. 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 DATE APPLICATION FOR AN AMENDMENT TO A PERMIT MA}~ - 1 200~ PHONE Soard of hustees ADDRESS AGENT PHONE ADDRESS PROPERTY LOCATION TAX MAP NO. -Sc. rl'~z~llk,-~f PROOF OF MAILING OF NOTICE ATTACH-CERTIFIED MAIL RECEIPTS Address: STATE OF NEW YORK COIJNTY OF-gUFFOLK ]XOo~ssa~ 0~ ~ - 6e~B{e~ , residing at 435 8e~d~o,.d P~ &4&o3~e ~ ~ ~ ~, being duly sworn, d~oses ~d says ~at on ~e 3 cci ~y of ~ ~ ,200 ~, deponent m~l~ a tree copy of~e Notice set foah in ~e Bo~d ofT~tees ~plication, direct~ to each of ~e above n~ pe~ons at the ad~esses set opposite ~ere re~tive ~es; that ~e M&esses set opposite ~e n~ of s~d pe~ ~e ~e ad&~s of smd perso~ ~ sho~ on the c~ent ~s~sment ~11 of~e To~ ~ Sou~old; ~at s~d Notices were m~l~ at ~e U~ted Stat~ Post O~ee at ~ N,,~'tc~ , ~at s~d Nofi~ we~ mM1M to ~eh ofs~d pe~o~ by (ce~fi~) (re~tered) m~l. Sworn to before me this ! 0 ~ Dayof /~a~ o~A ,20.__ P 'co U.S. Postal Service., CERTIFIED MAIL., RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) (Endomement Requrmd) Tot~ Po~ge & Fees 2.67 ~/~ U.S, Postal Service m CERTIFIED MAIL,. RECEIPT rtJ (Domestic Mail Only; No Insurance Coverage Provided) ,:0 Po~ s 0.37 ~IT I~: ~ Ce~fl~ F~ ~ R~tdct~ ~live~ Fee Clerk: ~ Total Pos~ge & F~S $ 2.~? U.S. Postal Service. CERTIFIED MAIL., RECEIPT ru (Domestic Mail Only; NO Insurance Coverage Provided) n postage $ 0.37 ~IT ID: 0?'32 Restricted Derive~ Fee Clerk: KRf(2f(,7 (Endorsemen[ Required) ru ToD, Po~ & F~ $ 2.67 03/09/05 P- - ~r66C,66S~o? .................................................... -- -- ~' -- = o ~ '9 ...... cO, LM'D-~, TL ~ U.S. Postal Service. CERTIFIED MAIL. RECEIPT 0.37 UNIT ID: Clerk: K~3 2.61 03/09/05 Albert J. Krupski, President James King, Vice-President Henry Smith Artie Foster Ken Poliwoda Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fex (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application ~etland Permit Application ~'~Major Waiver/Amendment/Changes ~Received Application: ~ ~2Received Fee:$ ,~e~Completed Application Incomplete SEQRA Classification: Type ! Type II Unlisted Coordination:(date sent) ~ CAC Referral Sent: ~ tOW ¥,,Date of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: Resolution: Minor JUN 2 5 2004 S0uth01d 10wa Board 0t Trustees Name of Applicant WILLIAM & DIANE BEARDSLEE Address 5 FERNCOTE LANE, BROOKVILLE, NY 11545 Phone Number: 516-626-7543 Suffolk County Tax Map Number: 1 O00 - 1164-24 Property Location: 435 BEACHWOOD ROAD, CUTCHOGUE (provide LILCO Pole #, distance to cross streets, and location) AGENT: EN-CONSULTANTS, 1NC. (If applicable) Address: 1319 NORTH SEA ROAD, SOUTHAMPTON, NY 11968 Phone: 631-283-6360 ,Board of Trustees Applici on Land Area (in square feet): 18,536.58 Area Zoning: R-40 Previous use of property: RESIDENTIAL. Intended use of property: NO CHANGE. GENERAL DATA 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? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): RAISE EXISTING GARAGE; RESURFACE EXISTING DRIVEWAY WITH PERVIOUS GRAVEL; REPLACE EXISTING SANITARY SYSTEM WITH NEW, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES-CONFORMING SANITARY SYSTEM TO BE ELEVATED 2' ABOVE GROUNDWATER BY APPROXIMATELY 355 CUBIC YARDS OF FILL AND CONCRETE RETAINING WALL; AND CONSTRUCT ACCESS STEPS OVER RAISED SEPTIC, ALL AS DEPICTED IN THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, LAND SURVEYOR, LAST DATED JUNE 14, 2004. RAISING AND EXPANSION OF EXISTING DWELLING AND ACTIVITIES ASSOCIATED THEREWITH, WHICH ARE LOCATED MORE THAN 10 FEET FROM TIDAL WETLANDS, ARE BEYOND TRUSTEES JURISDICTION PURSUANT TO SECTION 97-12(¢)(5). of Trustees Applica~n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: RENOVATE & RAISE EXISTING STRUCTURES TO COMPLY WITH FEMA BASE FLOOD ELEVATION REQUIREMENTS AND UPGRADE SANITARY SYSTEM TO COMPLY WITH SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES REGULATIONS. Area of wetlands on lot: 0 square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: +/-45 feet (GARAGE) Closest distance between nearest proposed structure and upland edge of wetlands: +/-45 feet (GARAGE) Does the project involve excavation or filling? No X Yes If yes, how much material will be excavated? N/__A cubic yards How much material will be filled? 355 cubic yards Depth of which material will be removed or deposited: 3.5 feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: APPROXIMATELY 335 CUBIC YARDS OF FILL WILL BE PLACED WITHIN AREA OF SEPTIC SYSTEM RETAINED WITH CONCRETE RETAINING WALLS, AS PER SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES REQUIREMENTS. 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): THE EFFECT OF THE PROJECT WILL BE IMPROVED STORM AND FLOOD PREVENTION AND ON-SITE WASTE TREATMENT, BOTH OF WHICH WILL HAVE A POSITIVE IMPACT ON THE PROTECTION OF ADJACENT TIDAL WATERS AND WETLANDS. PROJECT I.D. NUMBER 617.21 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) I APPLiCANT/SPONSOR: I 2. PROJECT NAME WILLIAM & DIANE BEARDSLEE BY EN-CONSULTANTS, INC. :3 PROJECT LOCATION: Municipality CUTCHOGUE County SUFFOLK 4 PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc, or provide map) 435 BEACHWOOD ROAD, CUTCHOGUE, TOWN OF SOUTHOLD, SUFFOLK COUNTY, SCTM #1000-116-4-24, MAP PROVIDED 1:$ PROPOSED ACT. L~N NeW LJ E..~nsio~l [] Modificatioru'aiteration SEQR 6 DESCRIBE PROJECT BRIEFLY: RAISE EXISTING GARAGE; RESURFACE EXISTING DRIVEWAY WITH PERVIOUS GRAVEL; REPLACE EXISTING SANITARY SYSTEM 'WITH NEW, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES-CONFORMING SANITARY SYSTEM TO BE ELEVATED 2' ABOVE GROUNDWATER BY APPROXIMATELY 355 CUBIC YARDS OF FILL AND CONCRETE RETAINING WALL; AND CONSTRUCT ACCESS STEPS OVER RAISED SEPTIC, ALL AS DEPICTED IN THE SITE PLAN PREPARED BY JOSEPH A. INGEGNO, LAND SURVEYOR, LAST DATED JUNE 14, 2004. RAISING AND EXPANSION OF EXISTING DWELLING AND ACTMTIES ASSOCIATED THEREWITH, WHICH ARE LOCATED MORE THAN 10 FEET FROM TIDAL WETLANDS, ARE BEYOND TRUSTEES JURISDICTION PURSUANT TO SECTION 97-12(c)(5). 7. AMOUNT OF LAND AFFECTED Initially 0.426 acres Ultimately 0.426 acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [] No If NO, descdbe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? [] Resid.ntia, [] Indu.tria[ [] Commercial [] Agriculture [] Park Forest/Open space [] Other Describe: lO. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL}? [] Yes [] No If yes, list agency(s) and permit/approvals DEC, SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES I t. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ]Yes [] No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION VVILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? []Yes []No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam~R~)~ERT E. HERRMANN, COASTAL MANAGEMENT SPECIALIST DATE JUNE 23, 2004 /17111 Signature: ""~L ~ ' -- , if the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER BOARD OF TRUSTEES, TOWN OF SODTBOLD In the matter of applicant:~qLLLAM&D1ANEBEARDSLEE SCTM#IO00-116~-~ Southold Towr~ YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: RAISE EXISTING GARAGE; RESURFACE EXISTING DPdVEWAY %qTH PERVIOUS GRAVEL; REPLACE EXISTING SANqTARY SYSTEM WITH NEW, SUFFOLK COUNTY DEPARTMENT OF HEALTH SER~qCES-CONFORMING SANITARY SYSTEM TO BE ELEVATED 2' ABOVE GROUNDWATER BY APPROX~dATELY 355 CUBIC YARDS OF FILL AND CONCRETE RETAINING WALL; AND CONSTRUCT ACCESS STEPS OVER POdSED SEPTIC, ALL AS DEPICTED FN THE SITE PLAN PREPARED BY 3OSEPH A. INGEGNO, LAND SURVEYOR, LAST DATED ZONE 14, 2004. RAISING AND EXPANSION OF EXISTING DWELLING AND ACTIVIRIES ASSOCIATED THERE%qTH, WHICH ARE LOCATED MORE THAN 10 FEET FROM ~DAL WETLANDS, ARE BEYOND TRUSTEES 3URISD1ClqON PURSUANT TO SECTION 97-12(c)(5). 2. That the property which is the subject of Environmental Review-is located adjacent to your property and is described as follows: 435 BEACHWOOD ROAD, CUTCHOGUE 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: 7/21/04 ~7:00pmYou may contact the Trustees Office at 765-1892 or in writing. The above referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. OWNERS NAME: V~LLIAM&DIANEBEARDSLEE MAILING ADDRESS: 5FERNCOTELANE BROOKV1LLE, NY 11545 PHONE #: 516-~6-7543 Enc.: Copy of sketch or plan showing proposal for your convenience. 5 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: MARGARET REINHARD REVOCABLE TRUST Address: 447 N. ROAD 33 LOT 449 LAKELAND, FL 33805 IMELDA & ROBERT GALLAGHER 74 KENWOOD ROAD GARDEN CITY, NY 11530 AMY & LEONARD WESSELL 375 BEACHWOOD ROAD SOUTHOLD, NY 11971 HAROLD OLSEN P.O. BOX 953 MATTITUCK, NY 11952 STATE OF NEW YORK COUNTY OF SUFFOLK ROBERTE. HERRMANNN 1319NORTHSEAROAD SOUTHAMPTON, NY 11968 doing business atEN~ONSULTANTS,~C' , being duly sworn, deposes and says that on the 29TH day ofJUNE ,2o 04, 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 addressesset 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 SOUTHANfPTON , that said Notices were mailed to each of (certified) ~) mail. Sworn to before me this 29TH day o~j Notary Publi~ C~i~nN~,~l~ said pers~s by 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, l)i~ne ~r',dr,d~le"6'_ ,residingat 6- ~f~p~ being duly sworn, depose and say: That on th%/~ day of/~ £6&.~ 200 , I personally posted the property known a~s 4~- /5~,ae_A~ood /do,ed ~Po/~o,Doe.. ~ t,.)'./ uq~'~ by placing the Board of Trustees official poster where it can casilybe seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of th.¢ public hearing. Date of hearing noted thereon to be held (d,/A~. J~/?g~. ~}~ca~)~ _ or) o0o. tt 9; 0Pn,/ Dated: (signature) Sworn to before me this day of.~gt ~t200 ,-RA:qK d. DECAROLIS .,~otery Public, State of New York No. 01 DE6080739 ?ualified inNassau CoLtnty i "UlS." Postal Service m CERTIFIED MAILM RECEIPT r-3 (Domestic Mail Only; No Insurance Coverage Provided) 123 _',, Postage $ 0.60 UNIT [t~: 0968 ~ S~TO Harold Olsen ~ P,O. Box 953 o~o0~N~ Mattituck, NY 11952 U.S. Postal Service m CERTIFIED MAILt,~ RECEIPT FU (Domestic Mail Only; No Insurance Coverage Provided) Po~ag* $ 0.60 /~lJ~iT I[~: 0968 (En~mementRequl~) ~ - ~Cled: ~0?F0 Amy & Leonard Wessell 375 B~chwo~ Road Southold, NY 11971 U.S. Postal Service CERTIFIED MAIL,,, RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) m sen~rd" Robert & lmelda Gallagher ~ 74 Kenwood Road r'- -i~tT~,'ib't;;%;Garden City, NY 11530 or PO Box No. U.S. Postal Sermce CERTIFIED MAIL,,., RECEIPT (Domestic Mail Only; No Insurance Coverage Provided) I LnKL"uf~E~, lq. ~ (Endowment R~ulred) 1.~ ' ~ ~.~ 06/29/~ M~garet Reinh~d Revocable Trust 447 N. Road 33 Lot 449 L~el~d, FL 33805 Albert J. Krupski, President James King, Vice-President ArCie 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 BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING , rv~z~a~ng~at 1515 NOl l liD. being duly sworn, depose and say: That on the ~ day of J~L~ , 200~, I personally~ posted the ~operty known as by placing the Bo~d of Trustees official poster where it c~ easily be seen, ~d that I have checked to be sure the poster h~ remained in place for ei~t.days prior to the dat~of the public hemng. Date ofhemng noted thereon to be held ~.. ~ ~ ~ ~ . om'o D~d: Sworn to before me this ,;7~'1~- dayo~ 200~/ ~6~ot ary--..Pub lic AUTHORIZATION (where the applicant is not the owner) (print owner of property) residing at ~ ~CO~_ ~n~--. (mailing address), do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. ( Owner ' s signature ) ' ' ~ard of Trustees Applicati~ County of Suffolk State of New York "~mn f ~)~a r~{ 51~' ~-- BE1NG 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 H/IS/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 TI-tIS APPLICATION. Signature SWORN TO BEFORE ME TI-IIS /3~ DAYOF ~'-/]-/t/ F~:~ANK J. DECAROLIS Notary Public, ,State of New York No, 01 DE6080739 Qualified inNassau CO_LI~ / Corem ssion Expires APPLICANT TRANSACTIONAL DISCLOSOR~ FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers add employees. The purpose of this form ie to provide information which can alert the town of possible conflicts of interes~ and allow it to take whatever action is necessary to avoid same. YOUR NAME~ (Last name, first name, midd.le initial, unless you are applying in the name of someone else or other entity, euotl es a company. If so, indicate the other person's or company's name.) NATURE OF APPLICATION~ (Check all that apply.) Tax grievance Variance Chan~s of zone App~va'l of plat Exemption from plat or' official map other (If "other," n,me the activity.) employee of tile Town of Soutbold? "Relationship" includes interest" means a business, including a partnership, in vhioh the town officer or employee has even a partial oenerehip of (or employment by) a corporabioa in ehic]l the town officer or employee owns more than 5~ of tile NO If you anevered 'YES," complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Soutbold 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. Tbs town officer or employee or }lis 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 applic~nt (when the applicant is a corporation)~ B) the legal or beneficial owner of any interest in s corporation)~ . C) an officer, director, pa~tnsr, or employee Of the , D) the actual applicant. DESCRIPTION OF R~LATIONSIIIP EN-CONSULTANTS, INC. ENVIRONMENTAL SERVICES '1319 Nodh Sea Road Southampton, New York 11968 631-283-6360 Fax: 631-283-6136 www. enconsulta nts.com June 23, 2004 Town of Southold Board of Trustees Post Office Box 1179 Southold, New York 11971 Attn.: Lauren Standish Re: William & Diane Beardslee 435 Beachwood Road, Cutchogue SCTM #1000-116-4-24 JUN 2 5 2004 Southold Town Board of Trustees Dear Ms. Standish: In regard to the above referenced property, enclosed are the following for the Board of Trustees review: 2. 3. 4. 5. 6. 7. Three (3) Wetland Permit Applications, Three (3) Short Environmental Assessment Forms. Three (3) copies of authorization & disclosure forms. Three (3) work plans. Three (3) copies of survey. One (1) set of site photographs. Application fee of $250.00. I trust this information shall allow you to process our permit request. Should any additional information be required, please do not hesitate to contact our office. Coastal Management Specialist /khs Enc. IJ ;j ../5.06"7-5 pscOS~-c {)[SC EXISTING EXISTING TOTAL £', PROPOSE PROPOSI TOTAL F PROPOS~