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HomeMy WebLinkAboutTR-5785 �O�*pF SO ®�o Michael J.Domino,President Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 jig P.O.Box 1179 Charles J.Sanders C, Southold,New York 11971 Glenn Goldsmith ��_�� �@ Telephone(631) 765-1892 A.Nicholas Krupski C�UN�,� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1334C Date: April 25, 2017 THIS CERTIFIES that a non-turf buffer based Won plan showing the area that is going to be restored; At 1460 North Oakwood Road, Laurel Suffolk County Tax Map#1000-127.-6-11 Conforms to the application for a Trustees Permit heretofore filed in this, office Dated June 16, 2003 pursuant to which Trustees Wetland Permit#5785 Dated July 23,2003,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 non-turf buffer based upon plan showing the area that is going to be restored. The certificate is issued to EMERY&MARY KORPI owners of the aforesaid property. m f Authorized Signature � T�, Michael J.Domino,President pF SO//� ®l0 Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 W Am P.O.Box 1179 Charles J.Sanders CA Southold,New York 11971 Glenn Goldsmith • a� Telephone(631) 765-1892 A. Nicholas KrupskiCOU� Fax(631) 765-6641 e BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 19, 2017 Karen J. Hagen, Esq. 16 Vista Court Riverhead, NY 11901 RE: EMERY & MARY KORPI 1460 NORTH OAKWOOD ROAD, LAUREL SCTM# 1000-127-6-11 Dear Ms. Hagen: The following action was taken at the Southold Town Board of Trustees regular meeting held on Wednesday, April 19, 2017: RESOLVED, that the Southold Town Board of Trustees APPROVE the request for a Transfer of Wetland Permit#5785 from Dena Shand to Emery & Mary Korpi, as issued on July 23, 2003. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. If you have any questions, please contact our office at (631) 765-1892. Sincerely, 8 Michael J. Domino, President Board of Trustees MJD/dd Michael J. Domino,President1 �SVFFO�/�- <�� �O C� _ Town Hall Annex John M. Bredemeyer II1,Vice-President �yj, 54375 Route 25 Charles J. Sanders ro P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski ' p! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time:_ y /1-7/1-2 B' yd Completed in field by: s j ,4 Karen Hagen, Esq. on behalf of EMERY & MARY KORPI requests a Transfer of Wetland Permit #5785 from Dena Shand to Emery & Mary Korpi, as issued on July 23, 2003. Located: 1460 North Oakwood Road, Laurel. SCTM# 1000-127-6-11 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action / Type of Application: Pre-Submission Administrative Amendment V Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: Okay Ic �tc,n,s �ec. Present were: J. Bredemeyer M. Domino ,//G. Goldsmith N. Krupski C. Sanders Other Page 1 of 2 `u�Foc,� Michael J. Domino,President �, � � �O CC � ' Town Hall Annex John M. Bredemeyer III,Vice-President „�� G� v 54375 Route 25 Charles J. Sanders z P.O.Box 1179 Glenn Goldsmith Southold,NY 11971 A.Nicholas Krupski ® Telephone(631)765-1892 HCl Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: Completed in Work Session by: Karen Hagen, Esq. on behalf of EMERY & MARY KORPI requests a Transfer of Wetland Permit #5785 from Dena Shand to Emery & Mary Korpi, as issued on July 23, 2003. Located: 1460 North Oakwood Road, Laurel. SCTM# 1000-127-6-11 Ch. 275-12 - STANDARDS FOR ISSUANCE OF PERMIT MET=X or Comment=* A. Adversely affect the wetlands of the Town: B. Cause damage from erosion, turbidity or siltation: C. Cause saltwater intrusion in the fresh water recourses of the Town: D. Adversely affect fish, shellfish or other beneficial marine organisms, aquatic wildlife & vegetation or the natural habitat thereof: E. Increase the danger of flood and storm-tide damage: F. Adversely affect navigation tidal waters or the tidal flow of the tidal waters of the Town: G. Change the course of any channel or the natural movement or flow of any waters: H. Weaken or undermine the lateral support of other lands in the vicinity: I. Otherwise adversely affect the health, safety and general welfare of the people of the Town: J. Adversely affect the aesthetic value of the wetland and adjacent areas: Ch. 111-9 - ISSUANCE OF PERMIT MET=X or Comment=* A. Is reasonable and necessary, considering reasonable alternatives to the proposed activity and the extent to which the proposed activity requires a shoreline location: B. Is not likely to cause a measurable increase in erosion at the proposed site and at other locations: C. Prevents, if possible, or minimizes adverse effects on natural protective features and their functions and protective values, existing erosion protection structures and natural resources: D. :525% Expansion/Calculation Work Session Notes Application Complete SEQRA Classification Confirmed Coordinated Review Y/N Pos/Neg Declaration CAC: LWRP: Additional information on comments/to be discussed/Public Hearing: Date: Completed By: Present: J. Bredemeyer M. Domino G. Goldsmith N. Krupski C. Sanders E. Cantrell D. Di Salvo Other Page 2 of 2 Cantrell, Elizabeth From: Karen Hagen <khesq@optimum.net> Sent: ,Wednesday,April 05, 2017 11:16 AM To: Cantrell, Elizabeth Subject: RE: Korpi property My address is 16 Vista Court, Riverhead,NY 11901 Or you can call me at 516-982-2112 and I will pick them up. This is being completed as a transfer and certificate of compliance? Thanks! Karen J. Hagen Attorney at Law NOTICE: This message, and any attached file, is intended only for the use of the individual or entity to which it is addressed, and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If the individual reading this message is not the intended recipient, you are hereby notified that any dissemination, distribution or copying of this message is strictly prohibited. Nothing in this e-mail message should be construed as a legal opinion. If you have received this message in error,please notify me immediately by replying to this e-mail and delete all copies of the original message. Thank you. On Wed, Apr 05, 2017 at 11:06 AM, Cantrell, Elizabeth wrote: Ms Hagen, The meeting that the transfers are determined to be approved by the Board is on April 19, 2017. Once approved, it can take up to two weeks to receive the transfer letter. Every month our office has a very large number of applications so it does take a little time to get the paperwork done. Can you please give me your mailing address as it is not in the application to transfer. Elizabeth From: Karen Hagen [mailto:khesq@optimum.net] Sent: Wednesday, April 05, 2017 10:58 AM To: Cantrell, Elizabeth Subject: RE: Korpi property 1 f •A Emery Korpi and Mary Korpi 40 Beatrice Avenue' Syosset, NY 11791 (516)342-0997 March 13, 2017 Southold Town Trustees 54375 Main Road, P.O. Box 1179 Southold, NY 11971 Re:Transfer and Final Inspection for Wetlands Permit#257/Trustees Permit#2103(to Land Use Company on behalf of Ian Shand dated 2/27/1986)and Trustees Permit#5785 (to Dena Shand dated 7/23/2003) To the Trustees of the Town of Southold: We have enclosed a check for$100 made payable to Southold Town Trustees for transfer and final inspection for Certificates of Compliance for the above numbered permits.We have also enclosed a copy of the deed that transferred title to us in 2013 and authorization for Karen Hagen(516-982-2112) and/or Diane Mollica (917-803-1915)to act on our behalf to schedule inspection,along with affidavit of authorization for the Trustees to enter the premises to conduct the inspection. If there are any further items that may be required, please contact our attorney, Karen Hagen,at 516- 982-2112. Thank you for your attention to this matter. Sincerely, r Emery Ko i h ` \ Mary Korpi enc. MAR 1 7 2011 i » - __ard of Trustees Applicati_— AFFIDAVIT Emery Korpi and Mary Korpi BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 7,a hof Propdrty Owner Signat re of Aroerty Owner SWORN TO BEFORE ME THIS `� DAY OF March ,20 17 Iic lC�U2EN J "AGEN• Wd ewpublit,Siata•of Nbw York Rb$iitratibn 002HA6312317 - 4 .ed Irr Suffolk County Coni ss�o"fi) 1p(rQsS�p4j*W29;2018 Lrd of Trustees Applicati.c AUTHORIZATION (where the applicant is not the owner) I, Emery Korpi and Mary Korpi residing at 40 Beatrice Ave., Syosset, NY 11791 (print name of owner of property) (mailing address) do hereby authorize Karen Hagen (Agent) and/or Diane Molfica to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (®wne signatur —�/ PAP Board Of Southold Town Trustees h SOUTHOLD, NEW YORK t PERMIT NO. � DATE: July 23,. 2003 ' DENA SHAND x ISSUEDTO ...........................................: ................. .d' 1 .�llltl�ljxt�Mftilri ", w Pursuant to the provisions of Chapter 615 of the Laws of l a the State of New York, 1893; and Chapter 404 of the Laws of the r = State of New York 1952; and the Southold Town Ordinance en- fitted ."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 r Resolution of The Board adopted at a meeting held on ..Julg._.2.3...... t 2003 and in consideration of the sum_ of x...100.00........ paid by x Dena Shand z, ..................._._........_.__.......... . ... ..._.... . E of ...........B.rc,okl .n.................................................... N. Y. and subject to the Terms and Conditions listed on the reverse side hereof, r &^ of Southold Town Trustees authorizes and permits the following: l Wetland Permit for a non turf buffer based upon plan showing the area that is going to be restore. all in accordance with the detailed specifications as presented in F 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 Board as of this date. cO� Trustees .r ------------ 11 t'; TERMS and CONDITIONS The Permittee !$4) North Oakwo N. Y' as residing at and to the fol- parr of the consideration for the iauance of the Permit does understand pteseslbe laving: 1. That the said Board of Trust= and the Town of Southold aft releasedany and all damages, or claims for damaEes, of auks arising directly cc indirectly as a result of any oPa' ation performed p ormant to this permit, and the said permittee will, at his at her own expense, defend any and all such adts'initlated by third poria, and the said Permfttre assumes full liability with respect tlerews to the complete'exclusion of the Board of Trussba of the Town of SoutboW 2. That this Permit k valid for a period of � moa. which is considered to be the estimated time'required to complete the work Involved, but should Citm warn warrant. quest se for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said permittee wishes to maintain the structure or project Involved, to provide evidence to anyone concerned that auth- orintion was originally obtained. 4. That the wodc.;nvolved will be subject to the inspection the Board attion and approval its agents, and non-complIsOm with.the provisions of the originating application, nay be case 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 work herein awhorized. 6. Thu there shall be no iDftd"eoae with the tight of the public to pass and tepass Idwo the beach between high and low water marks. 7. That if future operations of the Town of Southold require the semo+ap and/or alterations n of the wudc here in the (natioin authorised, th or if;in e opinion of the Board of Trustees, rite. wort shall cause unreasonable obstruction to free navigation, the said Permittee will be ngnised, Upon due notke, to remove or alter this work of project herein sated with" =Pru + to the Town of Southold 8. Thu the said Board will be notified by the Permittee of the compWon.of the week auth" ocised. 9. That the Permittee will obtain all other permits and consents that may be required alp• plemental to this permit which may be subject to revoke upon failure to obtain soma gOFFO�,� • Albert J. Krupski, President 0�0 CDTown Hall James King,Vice-President =� Ty 53095 Route 25 O P.O. Box 1179 Artie Foster N Z Southold, New York 11971-0959 Ken Poliwoda Peggy A.Dickerson Gif Telephone (631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 28, 2003 Ms, Dena Shand 89 Joralemon Street Brooklyn,NY 11201 RE: SCTM#127-6-11 1360 Oakwood Road Laurel,NY Dear Ms. Shand: The Board of Town Trustees took the following action during a Regular Meeting,held on July 23, 2003 regarding the above matter. WHEREAS,DENA SHAND applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated June 16, 2003 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 23, 2003 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. WHEREAS, the Board has determined that the project as proposed will not affect the health, 0 2 Safety and general welfare of the people of the town. NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve Wetland Permit for a non turf buffer based upon plan showing the area that is going to be restored. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency, which may also have an application pending for the same or similar project. Fee must be paid, if applicable and permit issued within six months of the date of this notification. If inspections are required, at a fee of$5.00 per inspection(See attached schedule). FEES: $5.00 Very truly yours, Az-r� 0 4-e-0-4 - ";1 . Albert J. Krupski, Jr. President, Board of Trustees AJK/cjc cc DEC Gg' M 0 cc 0 <' o o O _ Z c 5 / a id CL U n Q Z W c cq d¢ a) �� p c ¢ o 00 N � 3T�R/�5�10 cQ 1 • pi.OFp, y 74 �. A"VCaMC. �0 OWU�.+� 'ecvoeo ti �aD xa• — — i t„„o,,.K SEP - < �I 8 Southold Tawn • Board of Trustees 1 •� � t •,. y �I 4 Ian and Dena Shand • 89 Joralemon Street Brooklyn, NY 11201 718-624-0090 Board of Town Trustees Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Attention: Charlotte Cunningham August 29, 2003 RE: Forwarding of Drawing showing Agreed Plan of Action Ms. Cunningham: Enclosed is the drawing you requested in a phone conversation with my husband. The drawing summarizes the plan which my husband presented to the Board of Town Trustees on July 23, 2003 concerning my Application for a Wetlands Permit. Per my husband's presentation to the Trustees, my plan is to continue cutting back the Japanese Knotweed until we are able to lay down a double-layer of black plastic mulch over the infested area. According to the research that we did on this subject, these are the two non-chemical methods that are generally accepted by experts for dealing with Japanese Knotweed. A printed book of our research on the subject was submitted to Town Consul on July 23rd. The Knotweed infestation occupies a narrow band of shoreline along Brushes Creek approximately twelve feet wide and seventy feet long. This is the area we will cover with mulch for a period of about two years. If there are any further questions, please call me. Sincerely, D E C E Q V E 'E ' 2003 D Dena Shand Southold Town Board of Trustees Encl: Partial Survey Map 1460 N. Oakwood Rd, Laurel, NY showing area to be covered with black plastic mulch. Ian and Dena Shand 89 Joralemon Street Brooklyn, NY 11201 718-624-0090 Board of Town Trustees Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Attention: Charlotte Cunningham August 12, 2003 RE: Check for Permit Fee Ms. Cunningham: I received the notification you sent regarding the Town Trustees approval of my Application for a Wetlands Permit. Enclosed is a check (# 1447) in the amount of $5 to cover the Permit fee indicated in your letter. Either I or my husband will call soon to arrange the inspection stipulated in the letter. Thank you for your help. Sincerely, n Dena Shand R-rE;C Ur E 18 � D Encl: Citibank check #1447for $5 permit fee Southold Board of Thldm ofpFFOLIc Town Hall Albert J.Krups1d,President O�QS COG 53095 Main Road James King,Vice-President hQ. y� P.O.Box 1179 Henry Smith C3 0 Southold,New York 11971 Artie Foster da ,� Ken Poliwoda O Telephone(516)765-1892 y�ol �aO� Fax(516)765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: DENA SHAND Please be advised that your application, dated :T,,,,e16, 2003 _ has been reviewed by this Board, at the regular meeting of July 23 2003 and the following action was taken: (_ ) 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: One Inspection @$5.00 TOTAL FEES DUE: $ 5.00 SIGNED: 9. PRESIDENT, BOARD OF TRUSTEES BY: CLE OF rRUSTEES 4/9R 'Town riau Albert J.Krupski,President O�Of FOL OG • 53095 Route 25 James King,Vice-President • C P.O.Box 1179 Artie Foster �`Z` 'yj� Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson Telephone(631) -1366 92 P • � Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD I YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK,TO MAKE ANO SO APPOINTMENT FOR A HALL BE CONSIDERED A VIOLATION UAND POSSIBLE REV CATION OFCTION INSPECTION. FAILURE TO HE PERMIT. DENA SHAND INSPECTION SCHEDULE Pre-construction, hay bale line 15t day of construction '/2 constructed _ X Project complete, compliance inspection. Albert J.Krupski, President Town Hall James King,Vice-President • � C • P.O. Route 25 o P.O.Box 1179 Artie Foster Southold,New York 11971-0959 Ken Poliwoda CD Peggy A.Dickerson Telephone(631)765-1892 �y • !.F Fax(631) 765-1366 dol � Sao 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 15i day of construction % constructed Project complete, compliance inspection. �S�FFOLY�o� = Town Hall. 53095 Main Road P.O. Boz 1179 Telephone oyo� Southold. New York 11971 (631) 765-1892 Tye SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, July 15, 2003, the following recommendation was made: Moved by Donald Wilder, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit application of DENA SHAND to remove non-native plants, one oak tree, trim dead or diseased limbs from several oak trees an invasive Japanese bamboo, and replant with native plants and grasses and top dress with a thin layer of soil to promote the growth of the new plants and grasses. Located: 1460 Oakwood Rd., Laurel. SCTM#127-6-11 The CAC recommends Disapproval of the application and recommends a non-turf buffer and the use of native wetlands grasses and plants. Vote of Council: Ayes: All Motion Carried Ian and Dena Shand 16 89 Joralemon Street Brooklyn, NY 11201 718-624-0090 Board of Town Trustees Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Attention: Charlotte Cunningham June 27, 2003 RE: Second Check for An Application Fee for Permit (Previously Submitted) Ms. Cunningham: Per your telephone conversation with my husband Today, June 27'", 1 am enclosing a check (# 1422) in the amount of $60 to cover the increased application fee and penalty. This check combined with the one submitted previously together with the application (#1411 for $40) will bring the total amount thus submitted to $100. Thank you for your help in this matter.N Sincerely, � D JUN to sm Dena Shand Southold Town P 1�d atTr�s_ Encl: Citibank check #1422 for $60 additional application fee and penalty Ian and Dena Shand • 89 Joralemon Street Brooklyn, NY 11201 718-624-0090 Board of Town Trustees FE C v� " E Town of Southold D Town Hall 53095 Route 25 ;' r :`; ; P.O. Box 1179 Southold, New York 11971-0959 Southold Town June 11, 2003 BoardotTrustees RE: Application for Waiver Trustees: Enclosed are completed forms for an Application for Waiver. This application is made to cover work already completed and described in the application. Also enclosed is my check (#1411) in the amount of $40.00 to cover the application fee. I am submitting this application pursuant to a Notice of Violation, issued by Andrew Epple, Bay Constable dated May 16, 2003 (copy enclosed). This work was started and completed in November of 2002. At the time it was undertaken, I was unaware that a permit was required—especially in view of the project's modest scope and rehabilitationary nature. Sincerely, ( < /<- ' Dena Shand Encl:Application for Waiver (original form) Application for Waiver (two copies) Notice of Violation, Bay Constable, May 16, 2003 Citibank check #1411 for $40 application fee • NOTICE F ♦y Police Dept. - Bay Constable Town of Southold Peconic, New York 11958 NOTICE OF VIOLATION Date: ^4AY 16 @009 To: DEKA - AND (Owner or authorized agent of owner) Address: _ "�9 TOP_ALEMON ST. BROOKI.Yil N.Y. 11'201 (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 r)I ant iiigshL s has been done within 1O0ft of tine wetland withopritfirst obtaiai•iy a oerraii. irom TAF. S�!UTg0LD T0WN BOARD OF TRUSTEES You are therefore directed and ordered to comply with the following: APPLY FORA PERMIT FOR THE 'WORK ';!;AT iiAS SERV DONE on or before the 3'? day of June 20 03 . The premises to which this Notice of Violation refers are situated at: 1 4 G','a NORTF OAKWOOD DK, I AU^ L Town of Southold, Suffolk County, NY (Suffolk County Tax Map Designation: Dist. 1000 Section: 1@7 Block: Lot: t ) 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 Violations 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 w bf Southold, NY 1. Agency 'on/Precinct �g �l It 3.ORI 4.Q'01i9 5,Case No. 6.incident No. .. 1(1, �. jJt✓• 7 "T` NY2<-7 S- . ❑ Supp T Report Day 8,Date 9.Report Tine 10.Day 11.Dale q T me crMr4U 13.Day 14.Daze5 T rOrfl tck 1 Ime < V6 I „"� ., ti' ., � � iii �► ��' r ^3 /r• @ 16.Incident Type ,r 17.Busines Name 18.Weapon(,) A. O 5 n V 19,Incident Address(Street No,Street Name,BlllgNo.,Apt No) 20.City,State,Zip(❑C 0 C]V) 21 Location Code L 1l6 O /V7,JX, !;Y 'r B 22.Oh`F-l40. LAW'' fECTKNJ %A a CRTDEB: An t • Ft%B,EBjS {'Ts 23.Noof victims c. 1 2 24. No.of Suspects D 3 . ...VF ,TyAatGO;=fM1d lAlnm4-0t m(ytyp R6Pkr Nlnt@q =PZ.gQn}[¢pp(I09 qe lusep M(apd1�1¢��21NY YH fy &}s: s" `'. 26Viamalwcomplainant ❑Y❑N H t 'FM RAST.Fi85r,MIDDEE}... tBF D dF ftlnr ,6jNQER E- 2 - Birth S $ il T41 'Ld': .+ 6 G. aaf < V / sip 4t. c i I. 7p 27.Date of Binh 28,Age 29.Sea 30.Race 31.Ethnic 3Z.Handicap 33_Residence Status ❑Temp.Res.-Foreign Nat. Y .. ❑ M ❑ F ❑ White❑ Black❑Other ❑ Hispanic❑ Unk. ❑ Yes ❑ Resident ❑tourist❑Student I�I Other 1' Cl U [] Indian ❑Asian❑ Unk. ❑Non-Hispanic ❑No ❑Commuter❑Military ❑Homeless❑Unk 34.Type/No 3S.Name(Last,First.Middle) 36.AliaslNickname/Maiden Name(Last,First.Middle) 32.Apparent Condition k C " ❑ Impaired Drugs ❑ Mental Dis OUR 6 ❑ Impaired Alco ❑In)/III❑App Norm w 38.Address(Street NO.,Street Name.Bldg.NO,Apt.No.,City,State,Zip) 39.Poone NO. 40.Social Security No. ❑ Home L. Ow ❑ Work WN 41.Date of Birth 42.Age 43.Sex 44.Race 45.Ethnic 46 Skin 42.Occupation N� ❑ M ❑ F ❑ White❑ Black❑Other ❑ Hispanic❑ Unk. ❑ Light ❑Dark p �G ❑ U ❑Indian Asian ❑ Unk. M. N ❑ ❑ Unk. ❑Nois-Hispanic ❑Medium ❑Other Q ID 48.Height 49.Weight 50.Halt 51.Eyes 52.Glasses 53.Build 54.Employer/School 55.Address Z _ ❑ Yes C] Contacts ❑Small ❑Large N. sn � ❑ No ❑Medium N g 56.Scarp Marks Ranoos(Describe) 9.Misc. a 1 51.4k(BVr'It'i0M .r u'aA'. - rte: T ( t ip4tRp..i z 3 ' ~ 4 w 59 Vehicle [6W.License Plate No Full❑ 61.State 62.Evp.Yr. 63.%ate Type 64.Value �© Status Partial❑65 Veh.Yr. .Make 6J.MOdPI 68.Style 69.VIN, X 6 0 a 70.Color(s) n. Towed By 72.Vehicle Notes " S To: 23. / / 8 S u '/rC /ZP > / ilc 1c�i '' -1 1 11 1 1 Ye 9 tom,.:. / % i" I 10 `w l', i O/c ' �. r•r. , 12' l 6 ! 47 '1 -. 13 m 74.Inquiries(Check all that apply) 75. NYSPIN Message No. 76.Complainant Signature , > ❑ DMV ❑ Wanmarrant ❑ Scofflaw r ❑Crim.History ❑Stolen Property ❑ Other 'Q A. rti Hicer Sianatur Ind a k) 7810 No 29.Supervisor's Signature Rank) 80.ID No. But Bt.Status 0'00e •❑CIO, (If Closed,checkboxbelow) ❑Unfounded 82. Status Date 83. Notified7TOT 9 /Q,. ❑Via.Refused to Coop. C]Arrest ❑Pros.Declined ❑Warrant Advised .nyw I� f El Cal ❑luv.-No Custody ❑Arrest duv. C]Offender Dead ❑Ev[ratl.Devlin ❑Unknown S I /6 Y DUS-3205 (2/97) "FALSE STATEMENTS ARE PUNISHABLE AS A CRIME,PURSUANT TO THE NEW YORK STATE PENAL LAW. • NOTICE • Police Dept. - Bay Constable Town Southold COPYPeconic, Nee w York 11958 NOTICE OF VIOLATION Date: MAY 16 2003 TO: DENA SHAND (Owner or authorized agent of owner) Address: _ 89 JORALEMON ST. BROOKLYN N.Y. 11201 (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 planting has has been done within 100ft of the wetland without first obtaining a permit from THE SOUTHOLD TOWN BOARD OF TRUSTEES You are therefore directed and ordered to comply with the following: APPLY FOR A PERMIT FOR THE WORK THAT HAS BEEN DONE on or before the 30 day of June 20_U_. The premises to which this Notice of Violation refers are situated at: 1660 NORTH OAKWOOTI DR. T.ATIRFT. Town of Southold, Suffolk County, NY (Suffolk County Tax Map Designation: Dist. 1000 Section: 127 Block: 6 Lot: 11 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 w f Southold, NY . NOTICE • Police Dept. - Bay Constable Town of Southold Peconic, New York 11958NOTICE OF VIOLATIONcopl Date: MAY 16 2003 To: DENA SHAND (Owner or authorized agent of owner) Address: 89 JORALEMON ST. BROOKLYN N.Y. 11201 (Addru,,s 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 planting has has been done wit -Ln 100ft of the wetland without first obtaining a permit from THE 3OUTHOLD TOWN BOARD OF TRUSTEES You are therefore directed and ordered to comply with the following: APPLY FOR A PERMIT FOR THE WORK THAT HAS BEEN DONE on or before the 30 day of_ June ' 20 03 The premises to which this Notice of Violation refers are situated at: 1 460 NnRTTT nAKWnnP T)R_ T.AURFT Town of Southold, Suffolk County, NY (Suffolk County Tax Map Designation: Dist. 1000 Section: 127 Block: 6 Lot: 11 Failure to comply with the applicable provisions of the law may constitute an offense punishable by fine or imprisonment or both: NOTICE: 1 ou 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 Viciation. Such request shall have annexed thereto a copy of the Notice of Violation upon which a Hearing i: requested and shall set forth the reasons why such notice of viola- tion should be modified or rescinded Bay Constabl�w f Southold, NY Albert J. Krupski, President • �OSVFfO(�CO Town Hall James King,Vice-President hr� (may 53095 Route 25 o P.O.Box 1179 Henry Smith h Z Southold, New York 11971-0959 Artie Foster W Ken Poliwoda G 'g Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application _Major -4ZMino� —Waiver/Amendment/,Changes !x fe _Received Application: C. o \L� Received Fee:$ – , _Completed Application D _Incomplete SEQRA Classification: U 6 ZCG3 Type I_Type II_Unlisted Coordination:(date sent) _CAC Referral Sent' Southold Towo r' Board of fustees _Date of Inspection: ; O _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: _Public Hearing Held: 0 Resolution: Name of Applicant DEN A SHAM D ^\ Address $q JOR+4LENldN ST �jRODKLYf�J 1� Y 1120( Phone Number:( ) 719- 6;v4-colo Suffolk County Tax Map Number: 1000- 5ECnOW 127 'BLOCK OG LOT O I I Property Location: IHbO NORTH OAKW60D ROftD I-AUREL NY IIg4S Liuo ?OLE '# 1-11- 13A / ! 8 K1 NORTH Of I' CONIC 3AY $Luc, (provide LILCO Pole #, distancd to cross streets, and location) AGENT: (If applicable) Address: B111rd of Trustees Application• GENERAL DATA Land Area(in square feet): l.oT A?PROX. 222. D O 0 S4. FT. Area Zoning: 9E'S I DHNTIR L Previous use of property: RES I DUNTI A L Intended use of property: RESIDENTIAL Prior permits/approvals for site improvements: Agency Date BULLD/06 DEPT: tom 23' 1 6179- Z FOR }ID�ITION Of DECK TO OmE- fPtHILY DWELL,IN6 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspendo by a governmental agency? No Yes If yes, provide explanation: Project Description(use attachments if necessary): SEE A7Tf}CNHIENIT # Application Attachment#1 Application to Board of Town Trustees Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Name of Applicant: Dena Shand Address of Applicant: 89 Joralemon Street Brooklyn, NY 11201 Phone Number of Applicant: 718-624-0090 Project Description (page 2 of application): The goal of this landscaping was to trim dead or diseased limbs from several oak trees; to remove a dead oak tree; to remove non-native plants—in particular to remove an overgrowth of invasive Japanese bamboo; to replant with native plants and grasses; to top-dress with a thin layer of soil to promote the growth of new plants and grasses. The work included the following... 1. Remove one dead oak tree posing a danger to the dwelling. 2. Prune deadwood and diseased limbs from five oak trees also posing a danger to the dwelling. 3. Remove infestation of Japanese bamboo (non-native plant). 4. Remove two Russian Olive bushes (non-native plant). 5. Remove Privet hedge (non-native plant). 6. Prune overgrowth of bayberry bushes to encourage new growth and shape. 7. Top-dress area with approximately 2-inches of soil to promote growth of natural plants and grasses. 8. Lay fieldstone stepping-stones for natural appearance and walking safety. Ian and Dena Shand • 89 Joralemon Street Brooklyn, NY 11201 718-624-0090 Board of Town Trustees Town of Southold Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Attention: Charlotte Cunningham June 23, 2003 RE: Proof of Mailing of Notices to Adjacent Property Owners Ms. Cunningham: Enclosed is the signed and notarized Proof of Mailing of Notices to Adjacent Property Owners and the attached receipts. As you know, this notification is required for my application that you have previously received and is now before the Board. Per your telephone conversation with my husband Thursday, June 19t', I understand that a public hearing on this matter has been scheduled for 7:OOpm Wednesday, July 23, 2003. 1 also understand that as of Thursday, June I e you had not received a second check in the amount of $60 to cover the additional fees that you requested. If you still have not received that check, please be kind enough to contact me at 718-624-0090. Thank you for your help. Sincerely, &—�" <S '�-eq Dena Shand Encl: Proof of Mailing of Notice to Adjacent Property Owners 4x Certified Mail Receipts (attached) U.S. Postal Service,. U.S. Postal Service,. CERTIFIED MAIL,. RECEIPT rn i CERTIFIED MAIL. RECEIPT co (Domestic Mad Only; O (Domestic ra cc O N fliolli It X11743 r� DOTERSf�tINd5, f� 144 N N r-1 Postage $ 0.37 UNIT ID: 0948 ra Postage $ 0.37 IN NO Certified Fee 2 �' � N Certified Fee 2 ,vo/stm'�a-rk O '� Return Reclept Fee 1 << t O , (Endorsement Required) Here Return Reciept Fee (Endorsement Required) O (Endorsement Delivery Fee (f, ' G�. KT8fi05 a (Endorsement Requiretl) Up t O Restricted De livery Fee JJ ) � (Endorsement Required) N Total Postage&Fees ,$ 2'67 '�'�"y.hyf N Total Postage&Fees $ x•67 /D �5•/ • To a To M Sen�o1C�Irt...f4f�H/ ....��.0._llC�7 ,500Y�.._.. O _ C! `f�tS_ CJnITH�fJ__. 1NN_T IM L.. M1 Sbeat Apt Na.; f / �1 /y7 l A ; _ �I or Po Be.No. _ .6QG cN.__/ ' r ,I"�. ._l—{v.__. M1 Street Apt.No.; "7�,{.( p� ILCIiy,Sfefe,ZIP:4 II --_ or PoBOx No.- .�.___ l ALUL C5.._.__Ln fvt�- .f.._... le .. .. . III .. .. sm 3800,June 2002 See Reverse for Instructions NT L� I Ci NI Safe,Z/Pf41 S L� ��'1 vC PostalPostalceTPM rCERTIFIED MAILT. RECEIPTO CERTIFIED MAIL. RECEIPT S N (DomesticOnly; I. 0 0 -NfVZq-.wMr.TNFM .n �n N IBRI 'PLitTNS� f _ .-' " ti LAf#tEL, N1 1" • ru ra Postage $ 0.37 UNIT ID: 0948 Postage $ 0.37 �� UNIT ID: 0948 Certified Fee 2.30 �'Y' N Certified Fee ,:` `3 0 2.30 Postmark P _ � . Return Reciept Fee O Rehm Reclept Fee Herb .;�? C3 (ErMorsement Required) Here � (Endorsement Required) v p Restricted Delivery Fee IQ L^ ,R(L�-1�,, O Restricted Delivery Fee (Endorsement Required) 'C rr� " I � (Endorsement Required)„ 2.67 r Qfi�20/03 ` n I Total Postage&Fees 11 2.67 Qd/20 0 '•:' N Total Postage 8 Fees ,$ „/:._ g $ ru oant To_R!:Rr.Ce.... ..__T1.R/lFf�.__�_.G[.11t`. -...._..._ O� Sent To l''l p.•�. .I..11.?.....:Y--- -- - —. .tp..v.d _.._. M1 Street,Apt.No., M1 $Treat,Apt.No.; © . /� ... or PO BOX Na. � b_Gl ?"A11.�1_..._G.t t1__._...... or PO No. .--._____..1J.X...._._.... _�i ._y.,v____..__. �b.Smto, ' 0 P S t�LRitiS IJJ' C,y,Bate, tP.4 Q—EL Y PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Richie Hammel 19 Green Meadow Lane c/o Roy Fuchs (PoA) Huntington, NY 11743 Thomas and Cynthia Ann Trampel 4 Phillips Lane Chester Springs, PA 19425 Grace & Arden Hauser 326 Mountain Way Morris Plains, NJ 07950 Mr. & Mrs. John Ross P.O. Box 68 Laurel, NY 11948 RECF I PTS 11TT39GlfED To 67'tiFR STATE OF NEW YORK COUNTY OF SUFFOLK Dena Shand residing at 89 Joralemon 8rnnklvn my 9n1 being duly sworn, deposes and says that on the 23'd day of June 120 03deponent 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 Laurel, NY 11948 that said Notices were mailed to each of said persons by (certified) (registered)mail. 11 a Sworn to before me this 1;-) 3 rd Day of T,ne 20Q 3 O Notary Public two or OrYi� f , I ~ t Mmasm wvnm .-i ti ♦ n g YdE 4 P O yy @ T 659 ♦ \L w y £, y♦ ♦ �y ♦ ������� � 2 i It P . v♦ O s ♦ .. g v t w ♦ ur a -� ♦. y y \ a ♦ O m. � ° r -F 4 N ♦ I Ijg �O ° P P ♦ \ P ♦ t� I I p s �. /� q ♦ gg ill y P pj, yy �e ss - m „ rr. fill _ - se glllll �' N � 111111 +' asasss I -� all , M tl I�� IyA II( i r A ?I 11. .:Iii Boaid of Trustees Application• WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:RFNOVE DERE TREU- REKDUE OCAD a D1SF SED LIFISS oN OTHER TREES' REROUE INF;~MAnON of NON-NA71 LI' ►'�►Aert5 TDP- PRF^55 d' REPLAar WITH NATivE ?Lmz t-6RA55E5, Fr. SHojmu NE Area of wetlands on lot: -square feet Percent coverage of lot: /� —oJr Closest distance between nearest existing structure and upland edge of wetlands: q3 feet Closest distance between nearest proposed structure and upland edge ofwetlands: SAME feet Does the project involve excavation or filling? ✓ No Yes If yes, how much material will be excavated?NONE cubic yards How much material will be filled? NONE cubic yards Depth of which material will be removed or deposited: __1WI _44 Proposed slope throughout the area of operations: i_(ISTIN6 Manner in which material will be removed or deposited: 'BY 14AMD 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): NONE Board of Trustees Application County of Suffolk State of New York DENA SHAN D 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 AAPPPLICATION. Qp:f�--- I - cJ Signature SWORN TO BEFORE ME THIS_t_DAY OF Ua 200 3 rotary Pu is YITZCHOK RING Notary Public,State Of New York No. 01815015261 Ousllfied In Kinpe County Commiasion Expres July 19.2001 14-16-4(2157)—Text 12 PROJECT I.D. NUMBER 617.21 S EO 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 2. PROJ EC7 NAME DEN�9 S HAN D I �ENA'S PACKYAMD J. PROJECT LOCATION: Municlpalily 56(ATH DLA County SK IREM d. PRECISE LOCATION(Street address and road intersections, prominent landmarks, etc., or provide map) IN (o0 NORTH OAKWOOD ROAD LAUREL NY 11'gg9 P IsrKIr—lr 1000, SECTIOIJ- I�'f01' 3LOCk- 0(0 / LOT- O 11 LILCO TOLE # LIL - 13A - 5. IS PROPOSED ACTION: r�� C]New ❑Expansion L Mooificationialteration 6. DESCRIBE PROJECT BRIEFLY: REMOVE DEAD TREE' REMOVE DIE Db- DISEASED LIMM ON OTHER TREES REMOVE INFESTi'FTIOM Or NON- NATIVE ''LAMrS CJAPANESE $gHiWO); TOP- DRESS AND REPv4NT IUITH N.477UE- I?LAMT5 w- 6QASSE'5, 7. AMOUNT OF LAND AFFECTED: Initially n OI I acres Ultimately NOS I acres d. WILL >0POSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING I-:NO USE .RESTRICTIONS? Dyes ❑No If No, describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? rResldentlal r.!ndustnal r.Commercial U Agriculture '_'Park/Forest/Ocen space L_ Otner Desm oe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, ,NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)l J Yes U No If yes, list agency(s) and permittapprovals -S 11. DOES ANY A,r,S--,P/EECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes E<. If yes, list agency name and permitlapproval 12. AS A RESULT OF PyOPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE .Vi001FICATICN? ❑Yes rY'NNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE 70 THE BEST OF MY KNOWLEDGE II�� Applicarvspon r name: NTE Date: Signature: (!T- If the action is in -the Coastal Area, and you are a state agency, complete the iCoastal Assessment Form before proceeding with this assessment OVER 1 'N`/IFtONr�fENTA' 'S•SNIENT U - c oy .-'g i7C. - ?ART If ENV CR CC^,Cie!e^ • JC:S AC::CN E: CEEC ANY L 7mREZ�-iCt-D 'N 3 NYC=.=.. :>.nT 517 'Z If yes. aoc tamale :rte review access ane Asa –''!as —No 'NL._ I ..C'IC..N RECEIVE =C?CINAiEO REVION AS PR.CVICED CR'JNL:SSE7 ----71-'NS IN i N'M_RR. RAR7 St T9? If No. 3 negative cec:ar _ = may pe sucersegea cy 3nolner ,n,olvea agency. No C. CCULO AC-.ICN RESUL- '.N ANY ADVERSE ==C7.3 ASSGCf.:'C 'KITH -=E ROLLCWING. ;,answers nay ce nancwnnen. f eq,clel (;I. E.asiing air cuality, surfaca or grounawaler quality or cuanuty, nolle revels. ax:sUng :,critic patterns, so:ic .vaste grecucc:cn or glsoc potential for afosion, cramage or ',laoding croolems? Etolaln orietly: I C:!. AeSmedc, agricultural. 3rcnaeological. ais.onc, or otner.lamral or cultural :esourc_s: or community or ne:gnccrnood c=ac:er? _.colam ]r C:;. Vegetatlan or 'auna, rlsn. sneafisn or wildlife species, slgmricanr ttacitats, or :nreatanea or encangerea soec:es? Exclam odatly: CA. A cammun LY s existing plans or goals as oiflUaliv aaeoted.or a mange in use or Intensity at use of land or other natural resourcas? Explain gr C:.. Crowm, suoseeuent geveloomenl, or related activities likely to be induces Dy me proposed action? Explain Jr:erly. '_eng !arm, snort :erm. cumulative.or other edec:s not cemitiea in C.-05? °xolam pretty. i i . Ct.^.ef mgac:s (inc:acing :ranges in use of e:Iher quantity or type or energy)' E[olam orietly. J. 15 -HERE. OR lS '�,ERE '_:K c_f 70 3E,CGNTRGVE?SY ?ELATED TO POTENTUL ADVERSE '_.'+ViRCNMENTALJi:POC75? Yes No a Yes. exclain orietly I PART III—DET c3MINATION OF SiGNIFiCANCE (To oe comoleted by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large, important or otherwise signific "each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occp,,yng; (c) durations irreversibility; ;e) geogracnic scare; and (1) magnitude. If necessary, add attachments or reference supporting materials. Ensure explanations contain sufffcfent detail to snow that all relevant adverse impacts have been identified and adequately addressed. Check this box if you have identified One or more potentially large or significant adverse imcacts which M„'t - Occur. Then oreczeo directly to the ,FULL EAF ano/or prepare a positive•declaration. C peck :his box f you have determined, based on the information and analysis above and any su000rtinc coccmentaucn. :hat ;he prcooseo action 'HILL NOT result in,3ny significant adverse environmental imcac:_ AND :rcvice on attachments as necessary, the reasons supporting this determination: mt or .ec �+me >r tr.eemtom Jlnttr n .tie �geno LUe or tc:oonrmie Under i '. ::�na mre lr teleemoir :ni<.r n '.ma +veno i.xnamro or hepates to eu:erom corn reseonuom mncm Circ ^ • APPLICANT • _. TRANSACTIONAL DISCLOSURE FORM a The Town of Soui.hold'a code of Ethics prohibits conflicts of ! ntereet on the part of town off cera and employees. The purpose of this form is to rovide information which can alert the town of pose ble conEl cts of nterest and allow it to take whatever action is necessary to avoid same. touR MAME+ SH 1kAl A _ DENA Last name, first name, m ddla n t a 1�unless you are applying in the name of someone else or other entity, such as a company. If no, indicate the other person's or company's name. ) NATURE OLS APPLICATION: (Check all that apply. ) Tax grievance Variance change of zone Apppwal of plat Exelption from plat or official map other (If "other," name the activity. ) APPL(GATIoN Fdx_ 6i1 i—yep, Do you personallr (or through rout company, spouse, sibling, parent, or child) have a relationship with nor 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 torn africer or employee owns more than 5% of the shares. YES NOJZ If you answered "Y65,". complete the balance Of this form and date and sign where indicated. Name of person employed by the Town or Southold Title or position or 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 apace provided. The town officer or employee or Ilia 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); B) the legal or bbneficiai owner of shy interest in a noncorporate •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 RELATIONSIIIP submitted t a--', dayof„ 94 signature Print name .b Ihi0 FINZ 240 X52' \ \ S, rVP \ ar N 1 \ \ B COMC. fRTS CCW- OMI lit 301 .32' -ATTACH MENT d# Z partial Survey Map of 1460 North Oakwood Road showing... WORK AREA described in Application for Waiver SURVEY OF PROPERTY SITUATED AT LAUREL TOWN OF SOUTHOLD a 3„ SUFFOLK COUNTY, NEW YORK = S.C. TAX No. 1000- 127-06- 11 "m SCALE 1 "=20' am APRIL 26, 1999 O AREA = 21,666.11 sq. ft. 0.497 CO. NOTE: 2DCf�2 S�OeA �(�I� LOT NUMBERS SHOWN THUS: LOT 4 O REFER TO MAP OF LAUREL PARK \ \ P v FILE IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON OCTOBER 5, 1925 AS FILE No. 212 ;%A `A wapO ♦ �� Z o,P,WPC a CaHC IyALL ' S w ZQ" e�TESOORwMi Owl w N GABA In ae' SER W. U `� s 80 O , / 14 V/ LOT 47 J �u,r vae i caAo' F 0 ft PI o. OVER—va 'x'R"� N/0/KADSh(D'L ICxARD LpT 47 R P/O 1'0'r CERTIFIED TO: Iwo , � �' �s� IAN SHAND gS & Al�o g DOS COL LOT 47 UNAUTHORIZED MTERATUN OR ADDITION ":. ti^O,• " MpLLl P/p TO THIS SURVEY Is A V10uTION OF . . O' W. 69 p9 L MUCAnONzu OF THE NEW YORK STATE ' • O • S COPIES OF THIS SURVEY MAP HOT BEARING THE "AHO SURV F'S INNEO SFM OR . ' Z EMBOSSEDI SELL SHALL NOT BE CONSIDERED TO R! A VAUD TRUE COPY. CENTIMCATONSINDICATED HEREON SHALL RUN ONLY TO THE PERSON FDR WHOM THE SURVEY O N IS PREPARED, AND ON HIS BEHALF TO ME LENDING'�NSIIIPANYUIION USiEOTMEREO ANDTMUE A- AGENCY D Oy TO THE ASSIGNEES OF THE EENMNG INST- "ON. CERIIFICATONS ARE NOT TRANSFERABLE. f THE EXISTENCE OF RIGHTS OF WAY AND/OR EASEMENTS OF RECORD, IF ANY, NOT SHOWN ARE NOT GUARANTEED. IVA�\ A. ` ` 1 -0 PREPARED IN ACCORDANCE WITH THE MINIMUM ��.N 00 v TFOSUCH STANDARDS USE THE ORK S TAS Joseph A. Ingegno FOR SUCH USE BY THE YORK SPATE VJiO gyp, IDLANO Land Surveyor O SO �G Title Surveys — Subdivisions — Site Plana — Construction Lo}rout PHONE (516)727-2090 Fax (516)722-5093 9rF F E`A1yO OFFICES LOCATED AT MAILING ADDRESS N.Y.S. Lie. No. 49668 One Union Square P.O. Box 1931 Aquebogue, New York 11931 Riverhead, New York 11901 —2