HomeMy WebLinkAboutTR-6521
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES
72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN
APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO
SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE
PERMIT.
INSPECTION SCHEDULE
~pre-construction, hay bale line'
1 sl day of construction
Y:, constructed
7
Project complete, compliance inspection.
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TERMS AND CONDITIONS
The Permittee Jack DaSilva, residing at 136 NisseQuogue River Rd" Smithtown, NY, as part of
the consideration for the issuance of the Permit does understand and prescribe to the following:
I. That the said Board of Trustees and the Town of Southold are released from any and all
damages, or claims for damages, of suits arising directly or indirectly as a result of any
operation performed pursuant to this permit, and the said Permittee will, at his or her own
expense, defend any and all such suits initiated by third parties, and the said Permittee
assumes full liability with respect thereto, to the complete exclusion of the Board of
Trustees of the Town of Southold.
2. That this Permit is valid for a period of 24 months, which is considered to be the estimated
time required to complete the work involved, but should circumstances warrant, request 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
authorization was originally obtained.
4. That the work involved will be subject to the inspection and approval of the Board or its
agents, and non-compliance with the provisions of the originating application 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 work
herein authorized.
6. That there shall be no interference with the right of the public to pass and repass along the
beach between high and low water marks.
7. That if future operations of the Town of Southold require the removal and/or alterations in
the location of the work herein authorized, or if, in the opinion of the Board of Trustees,
the work shall cause unreasonable obstruction to free navigation, the said Permittee will be
required, upon due notice, to remove or alter this work project herein stated without
expenses to the Town of Southold.
8. The Permittee is required to provide evidence that a copy of this Trustee permit has been
recorded with the Suffolk County Department of Real Properties Office as a notice
covenant and deed restriction to the deed of the subject parcel. Such evidence shall be
provided within ninety (90) calendar days of issuance ofthis permit.
9. That the said Board will be notified by the Permittee of the completion of the work
authorized.
10. That the Permittee will obtain all other permits and consents that may be required
supplemental to this permit, which may be subject to revoke upon failure to obtain same.
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
January 24, 2007
Ms. Sylke K. Schade
A.M. Sutton Associates, Inc.
278 North Country Rd.
P.O. Box 5220
Miller Place, NY 11764
RE: JACK DASILVA
470 TARPON DR., SOUTHOLD
SCTM#57 -1-4
Dear Ms. Schade:
".
The Board of Town Trustees took the following action during its regular meeting held on
Wed., January 24, 2007 regarding the above matter:
WHEREAS, A.M. Sutton Associates, Inc. on behalf of JACK DASILVA applied to the
Southold Town Trustees for a permit under the provisions of Chapter 275 of the
Southold Town Code, the Wetland Ordinance of the Town of Southold, application
dated November 4, 2006, and,
WHEREAS, said application was referred to the Southold Town Conservation Advisory
Council and to the Local Waterfront Revitalization Program Coordinator for their findings
and recommendations, and,
WHEREAS, the LWRP Coordinator issued a recommendation that the application be
found Consistent with the Local Waterfront Revitalization Program policy standards,
and,
WHEREAS, a Public Hearing was held by the Town Trustees with respect to said
application on January 24,2007, at which time all interested persons were given an
opportunity to be heard, and,
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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 275 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 have found the application to be Consistent
with the Local Waterfront Revitalization Program, and,
RESOLVED, that the Board ofTrustees approve the application of JACK DASILVA to
construct a two-story 3500 sq.ft. single-family dwelling and garage, with the condition
drywells are installed to contain the roof run-off, and a line of staked hay bales is
installed along the non-disturbance buffer, 25' off the rear of the proposed dwelling, and
as depicted on the plans prepared by Hawkins, Webb, Jaeger Assoc., P.C. last dated
March 2007.
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: $100.00
Very truly yours,
~o;r~
Jamt~~ King - ;/
President, Board of Trustees
JFKllms
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James F. King, President
Jill M, Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
, Bob Ghosio, Jr.
TO:
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
A . r1- iA-t--to" It s '>0'- . ~. So. c k
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Please be advised that your application dated
reviewed by this Board at the regular meeting of
following action was taken:
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Town Hall
53095 Route 25
P.O. Box 1179
Southold,'New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
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L.J Application Denied
(see below)
L-) 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 Chapter 97 of the South old Town
Code,
The following fee must be paid within 90 days or re-application fees will be necessary.
COMPUTATION OF PERMIT FEES:
$\S-D
j{ 50
~'-1 h- Ie. \ (IS r~c--hoiV
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TOTAL FEES DUE: $ 100
BY: James F. King, President
Board of Trustees
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From: Robert Schiavetta
320 Tarpon Drive
Southold, New York 11971
DEe 1 1 2006
To: Board of Town Trustees
Town of Southold
Re: Jack Dasilva request for a Wetland permit for a two story, 3,500 sq. foot single family dwelling at 470
Tarpon Drive, Southold. SCTM#57-14
Dear Board Members:
I am writing you today as a home owner in the Southold Shores Community. My home is located at 320
Tarpon Drive, Southold,just to the right of the Dasilva property. As you know, the Southold Shores
Community is an environmental y sensitive area In recent years, the issues have grown and have become
more numerous. The building of houses in the area has disturbed the natural flow of water, involving
streams and underground springs. The Wetlands have heen encroached upon leaving too few areas to
process the water. Because of previous new constructions land areas and basements normally dry ,have
become flooded. The area behind my property and the Alhacore properties, which used to contain a 30
foot pond, that would run off to the property along Route 25 has grown now to a length of over 200 feet.
This area becomes even larger during rainfalls and creates additional areas of water pooling.
This brings me to some of my concerns in regard to the new construction.
I. The property that adjourns the Dasilva property in the rear is not the Northrop property but is the
Proposed Canal Property owned by a Southold Shores LLC which needs to be informed before
consideration of the permit.
2. The water table in our area had risen about 2 feet between the time of our Test Dig in 2002 until the
placing of our cesspools in 2004. I do not think that a test hold dug in 1998 for the Dasilva permit is a good
gauge for determining the water table at this time.
3. New basements if allowed to be built may cause additional disturbances to the area, as we have seen
recently because of two properties on Albacore.
4. If a basement is going to be attempted and the water table is higher than expected just how will the first
floor elevation be allowed to be raised? It is now set on the drawing at 12.1 feet. My first floor elevation is
13 feet. As we know, the elevations and basements at the new houses on Albacore have caused needless
flooding to adjourning properties and basements. This situation has also coutnbuted to the increase of
water in the previously mentioned Wetland Area.
5. The amount of fill that is intended to be brought in for the Dasilva property seems quite excessive if only
to raise the area with normal grading.
6. This house proposal at 3,500 sq. feet and 80 foot across the front seems excessive for our street for only
a y, acre lot. I also see that the house proposed on the DEC PERMIt is not the same size house being
proposed to the Trustees. The depth went from 38 feet to almost 45 feet and the length across the front
went from about 60 feet to 80 feet. What is the percent of property to be covered?
Once again, I am asking the Trustees to consider these concerns and any other concerns that you might
be considering, not to stop the construction of a house but to guide the limitations of our concerns in order
not to allow further deterioration of our Wetlands and our Community.
Thank you for your time,
Robert Schiavetta
iiI
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Telephone
(631)765-1892
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
CONSERVATION ADVISORY COUNCIL
TOWN OF SOUTH OLD
At the meeting of the Southold Town Conservation Advisory Council held Wed.,
December 6, 2006, the following recommendation was made:
Moved by James Eckert, seconded by Peter Young, it was
RESOLVED to SUPPORT the Wetland Permit application of JACK DASILVA to
construct a two-story 3500 sf. single-family dwelling.
Located: 470 Tarpon Dr., Southold. SCTM#57-1-4
Inspected by: James Eckert, Peter Young
The CAC Supports the application with the Condition of a 20' non-disturbance buffer.
Vote of Council: Ayes: All
Motion Carried
Do- <; ; \ v 0.
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James F. King, President
Jill M. Doherty, Vice,President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field InspectionIW ark session Report
Date/Time: I). { (p / Ora
AM. Sutton Assoc. on behalf of JACK DASILVA requests a Wetland Permit to
construct a two-story 3500 sf. single-family dwelling. Located: 470 Tarpon Dr.,
Southold. SCTM#57-1-4 .
Type of area to be impacteli:
_Saltwater Wetland j,LFreshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Pal! of Town Code proposed work falls under:
_ithapt.275 _Chapt. 111_other
Type of Application: J Wetland _Coastal Erosion _Amendment _Administrative
_Emergency
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Mailed/Faxed to:
Date:
Environmental Technician
Review C\-'eck.. we-tI(A~J
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New York State Department of Environmental Conservation
Division of Environmental Permits
Buil.ding 40 - SUNY, Stony Srook, NY 11790-2356
T~9phone(6311444-o365
Faoslmilo (6311444-0360
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ErIn M '. Crot1Y..
commissioner
August 8,2003
NOV - 4 L~06
:Mr. Jack DaSilva
5 Cakewalk Terrace
Srnrthtovnl,}r{ 11787
RE: 1-4738-02097/00001
Dear Permittee:
In conformance with the requirements ofthe State Uniform Procedures Act
(Article 70, ECL) and its implementingregulations (6NYCRR, Part 621) we are
enclosing your permit. Please read all conditions carefully,lfyou are unable to
comply with any conditions, please contact us at the above address,
Also enclosed is a permit sign which is to be conspicuously posted at the
project site and protected from the weather.
~
Susan V. Ackerman
Environmental Analyst
SV Ails
,O'd 80:0, 900~ O~ lor
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NEWeK STATE DEPARTMENT OF ENVlRONMENTA_SERVATION
DEC PERMIT NUMBER
1-4738-02097/00001
FACILITY/PROGRAM NUMBER(S)
e
-PERMIT
Under the Environmental
Conservation Law
EFFECTIVE DATE
Auoust 11. 2003
EXPIRATION DATE(S)
August 1 ~, 2 008
TYPE OF PERMIT. New 0 Renewal 0 Moomaaoon 0 Permit to Construct 0 Permit 10 Operate
o 6NYCRR 608: Waler Quality Certifica-
t1
. Article 25: Tidal Wetlands
o Article 27, Title 7; 6NYCRR 360:
S I'd
o Article 27, Title 9; 8NYCRR 373:
Hauroaus. Waste Management
o Article 34: Coastal Erosion
Management
o Article 36: Aoedplain Managament
o Articles 1. 3.17,19, 27.37; 6NYCRR
380: Radiation Centrel
o Article 15, TItle 15: Water Supply
o Mele 15, TiOe 15: Water Tran.porl
o Article 15, TiOe 15: Long 1~land Wells
[J Artiole 15, T1tIe 27: Wild, Scenic and
Recreational Rivers
o Article 17. TiOes 7, 8: SPnES .
o Article 19: Air PoUution Control
o Article 23, TiOe 27: Mined Land
Reclamation
o Article 15, Title 5: Pmleotian of Waters
o Article 24: Freshwater Wetlands
an o I W:lirte Manaaement
PERMIT ISSUED TO . TELS>HONE NUMBER
Jack Da Silva I (516) 724-3661
ADDRESS OF PERMITTEE
I
5 Cakewalk Terrace, Smithtown. NY 11787 .
CONTACT PERSON FOR PERMITTED WORK TElEPHONE NUMBER
Steve Cataldo, AlA, 14 Karl Avenue, Smlthtown. NY 11767 (631) 724-2141
NAME AND ADDRESS OF PROJECT/FACILITY
Da Silva Drooertv. Route 25 and Taroon Drive. Southold SClM #1000-57-1-4
COUNTY TOWN WATERCOURSE NYTM COOROINA TES
Suffolk Southold Man Made Canal
DESCRIPTION OF AUTHORIZED ACTIVITY:
Construction of a single family dwelling with garage, driveway and septic system In accordance with plans
stamped NYSDEC approved on August 11, 2003. This project has also been reviewed under Article 24-
Freshwater Wetlands and is not within NYSDEC Freshwater Wetland Jurisdiction.
By ac;ceplance of this penmit, the pennittee agrees that the permit is contingent upon strict compliance with the Eel, ell
applicable regulations, the General Conditions specified (see page 2 & 3) md any Special Conditions Included as part
of this pennlt
PER.MIT ADMINISTRATOR;
ADDRESS
Ro er Evans (SVA)
AUTHORIZED SIGNATURE.
ion 1 Headquarters, Bid .1140, SUNY, Ston Brook. NY 11790.2356
DATE
Page 1 of4
Au ust 8. 2003
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09~Ovvv!~9:KE~ SlIW~3d NO~IAN3 J3GSAN
.. 'YORK stATE OEPARThIE~T OF ENVIRONMENTAL c
SPECIAL CONDITIONS
VATlON
1. During construction, concrete or leachate shall not escape or be discharged, nor shall washings from transit mix
trucks, mixers, or other devices enter tidal wetiands and or protected buffer areas.
2. Any debris or-excess material from construction of this project shall be C(lmpletely removed from the adjacent area
(upland) and removed to an approved upland area for disposal. No debris Is permitied in tidal wetlands and or
protected buffer areas.
3. Necessary eroSion control measures i.e., haybales, silt fencing, etc. are to be placed on the downslope edge of
any disturbed area. This sediment barrier is to be put in place before any disturbance of the ground occurs and is to
be maintained in goad condition until thick vegetative cover is established.
4. Roof runoff must be directed to drywells a minimum of 75 linear feet landward of the most landward edge of the
tidal wetland boundary, and must be installed a 'minimum of2 feet above seasonal high groundwater.
5. Driveways and parking areas shall be constructed of perviOUS material.
6. Sanitary system (bottom of tank and 1....chinS pools) shall be loealed " minimum of 2' above seasonal high
groundwater. '
OEC pERMIT NUMBER
PAGE2of4
1-4738-02097/00001
m'd
60:0T 900~ O~ In[
09~Ovvvl~9:X~~ SlIW~3d NO~IANG J3GSAN
. NEW YORK STAlE DEPM1"'ENTOF ENVlRONMENT.NSERVATION
ADDITIONAl. GENERAL CONDITIONS FOR ARTICLES 15 (TITLE 5). 24, 25, 34 AND 6NYCRR PART 608
(TIDAL WETLANDS)
,
1. If future oPElrations by the State of New York require an alteration In ihe position of the structure or work herein
authorized, or if, In the opinion of the Department of E:nvironmenlal Conservation It shall cause unreasonable
obstruction to the free navigation of said waters or flood flows or endanger the health. safety or welfare of the
people of the State, or cause loss or destruction of the natural resources of the State, the Owner may be ordered
by the Departmentto remove or alter the structural work, Obstructions, or hazards caused thereby wIthout expense
to the State. and if, upon the expiration or revocation of this permit, the structure, fill, excavation, or other
modification of the watercourse hereby authorized shall not be completed, tlia owners, shall, without expense to
the State, and to such extent and in such time and mannerss the Departmentof Environmental Conservation may
require, remove all or any portion of the uncompleted structure Qr fill and restore to ils former condition the
navigable and flood capacity of the watercourse. No claim shall be made against the State of New York on
account of any such removal or alteration.
2. The State of New York shall in no case be liable for any damage or Injury to the structure or work herein
authorized which may be caused by or result from future operations undertaken by the State for the conservation
or Improvement of navigation, or for other purposes, and no claim or right to comperv;atlon shall accrue from any
. such. damage.
. . I j :
3. Granting of this permit does not relieve the applicant of the responsibility of obtaining any oth.er permission,
consent or approval from the U.S. Anny Corps of EngIneers, U.S. Coast Guard, New York Stete Office of General
Services or local government which may be required. '
4. All necessary precautions shall be taken to preclude contamination of any wetland or waterway by suspended
solids, sediments, fuels, solvents, lubricants, epoxy coatings, paints, concrete, leachate or any other
environmentally deleterious materials associated with/he project.
6. Any material dredged in the conduct of the work herein permitted shall be removed evenly, without leaving large
refuse piles, ridges across the bed of a waterway or floodph.ln or deep holes that mey have a tendency to cause
damage to navigable channels or to the banks of a waterway.
6. There shalf be no unreasonable interference with navigation by the work herein authorized.
7. If upon the expiration-or revocation of this permit. the project hereby authorized has not been completed, the
applicant shall. without expense to the State, and to such extent and in such time and manner as the Department
of Environmental Conservation may require, remove all or any portion of the uncompleted structure or fill and
restore the site to its former condition. No claim shall be made against the State of New York on account of any
such removal or alteration.
8. If granted under6NYCRR Part608, the NYS Department of Environmental Conservation hereby certifies that the
subject project will not contravene effluent limitations or other limitations or standards under Sections 301,302,
303.306 and 307 of the Clean Water Act of 1977 (PL 96-217) provi:led that all of the conditions listed herein are
met.
9. Alleast 48 hours prior to commencement of the project the permittee and contractor shall sign and return the top
portion of the enclosed notification form certifying that they are fully aware of and understand ail terms and
conditions of this permit. Within 30 days of completion of project, the bottom portion of the form must also be
signed and returned. along with photographs of the completed war!: and, if required, a survey,
10. All activities authorized by this permit must be in strict conformance with the approved plans submitted by the
applicant or his agent as part of the permit application.
Such approved plans were oreoared bv Hawkins, Webb & Jaeger dated 9/1998 and last revised on il 'l~ Ib(
DEC PERMrT NUMBER
PAGE 3 OF 4
1-4738-02097/00001
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09ml717171>:9:X~.:l SlIW~3d NO~I!\N3 J3GSAN
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NEW YOR~ STATE DEPARThlENT OF 5NIIlRONMEN
SERVATION
NOTIFICATION OF OTHER PERMITTEE OBLIGATIONS
, Item A: Permittee Accepts Legal Responslbiiity llnd Agrees to Indmmiflcation
The permittee expressly agrees to indemnify and hold harmless the Department of Environmental Conservation of the
State OfN~w York,lts representativ~s, employee~, and agents C'DEC') for all claims, suits, actions, and damages, to the
extent a.ttributable to the permittee s acts or omissions In connection IWh the permittee's undertaKing of activities in
connection wit", or operation and maintenance of, the faCIlIty or facilities authorized by the permit whether In compliance
or not in compliance with the terl1lS and conditions of the permit This indemnification does not extend to eny claims,
suits, actions, or damages to the extent attributable to DEe's own negllsent or intentional acts or omissions, or to any
claims, suits, or actions naming the DEe and arising under article 78 of the New York Civil Practica laws and Rules or
any citizen sull or civil rights provision under federal or state laws.
Item B: Permittee's Contractors to Comply with Permit
The permittee' Is responsible for Informing its Independent contrac\Qil;, employees, agents and assigns of their
responslbJllty to comply with this permit, including all special conditions wHle <<cting as the permittee's agent with respect
to the permitted activities, and such persons shall be subject to the same sanctions for violations of the Environmental
Conservation Law as those prescribed for the permittee.
ItelTl c: Pennittee ResponsIble for Obtaining Other Required Pemlts
The permittee is responsible for obtaining any other permits, approvals, lands, easements and rights-Of-way that may
be required to carry out the activities that are authorized by this permit.
Item 0: No Right to Trespass or Interfere with Riparian Rights .
This pelTl)it does not convey to the permittee any right to trespass UpOl the lands or interfere with the riparian rights
of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real
or personal property held or vested in a person not a party to the permll.
GENERAL CDNDlT1pNS .
General CondItion 1: Facility Inspection by the Department
The permitted site orfacilily, including relevant records, Is subject to inspection at reasonable hours and intervals by
an autho~ed representative of the Department of Environmental Conseffation (the Department) to determine whether
the permittee is complying with this permll and the ECl. Such representaive may order the work suspended pursuant
to ECl 71-0301 and SAPA 401(3).
The permittee Shall provide a person to accompany the Departmenfs re/resentative during an inspection to the permit
area when raquested by the Department
A copy of this perm~, Including all referenced maps, dmwlngs and specill conditions, must be available for Inspection
by the Department at ell times at the project site or facility. Failure to pro:luce a copy of the permit upon request by a
Department representative Is a violation of this permit
General Condition 2: Relationship of this Pennlt to Other Deparlment aide.... and Detenninations
Unless expressly provided for by the Department, Issuance of this pemit does not modify. SUpersede or rescind any
order or determination previously Issued by the Department or any of the terms, conditions or requirements contained
in such order or determination.
General Condition 3: Applications for Permit Renewals or ModlncatioJ\s
The permittee must submit a separate written application to the Departrrentfor renewal, modification or transfer of this
permit. Such application must include <<ny forms or SUpplemental Information the Department requires. Any renewal,
modification or transfer granted by the Department must be in writing.
The permittee must submit a renewal application at least:
a) 180 days before expiration of permits forStete Pollutant Dischaye Elimination System (SPDES), Hazardous
Waste Management Facilities (HWMF), major Air Pollution Conlrol (APC) and Solid Waste Management
Facilities (SWMF); and
b) 30 days before expiration of an other permillypes.
Submission of applications for permit renewal or modification are to besubmilted to:
NYSOEC Regional Permit Administrator, Region 1. SUNY Bldg #41, Stony Brook NY 11790-2356
General Condition 4: Pennit Modifications. SuspenSions and RevocatlollS by the Department
The Department reseNes the right to modify, suspend or revoke this pennitln accordance wlth 6 NYCRR Part 621. The grounds
for modlfleation. suspension or revocation Include:
a) materially false or inaccurate statements in the pennit application or supporting papers;
b) failure by the penniltee to comply with any tenns or conditions of the pennit:
C) exceeding the scope of the project as described in the pennit appllcafun; .
d) newly dISCOvered material infonnation or a material cl1ange in envlronnental conditions, relevant technology or applicable
law or regulations since the issuance of the existing pennlt;
e) noncompilence w~h previously issuad permitcondiftons, orders of the <<>mmlssioner, any provisions o/the EnVironmental
ConseNatlon Law or regulations o/the Department related to the pemitted activity.
OECPEPlMITNUMSER PAGE 4 OF 4
1-4738-02097/00001
SO'd
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TARPON DRIVE (50')
+8.9' +9.1' +9.2' +9.2' +9.2'
w II' II' II' II' II' II'
I~;t 10. ar-~.rw " NT
~aoi II' MACHINERY AC
ALONG PROPO~
-E i!' 115.OIJ'
~
"" <oj Vl- 8'
ll) ~
(\I :; ~
. s .., C;; ~7'
II: 1l: .. .5+ .
'" INV, ~.B 0
. <E .
CD ..., \ \ '-.... .. ;:e
V OJ tl ......- b
OI..la~' ~ .
0 ~ 1~~ 10.0\ f.3/ I
,..0.
,8"6
~ PROPOSED -.,
LOT 43 \ b DWE:LLING I LOT 41
VACANT III FF=12./' VACANT
22.0'
-a: b
S!
Z - "'-.. -
-
c( 6'
~ 6'
g
!'\
'"
.... -
PI . ~
g g
~ .
N 63"52 '30 W 115.00' \~
"
'-. 105
"--.....---
PROPOSE:D CANAL (NOT CO!
T
90'd
Ol:Ol 900l Ol In[
0900vvVl~g:xe~ SlIWa3d NO~IAN3 )3GSAN
-.._. ..._ "" . _. .,1 ..,.0' . _......._ ..._-'
SuFFOLK COUNTY D~TMENT OF HEALTH SERVICES
;( OFFICEOFW~WATERMANAGEMENT
. '360 Y APHANK AVENUE, SUITE ZC, Y APHANK, NY 11980
i" , (63l):?~.i~5;>QQ, ,
",'.." - c" ,1;'
CE USE ONLY
Health Deparbnent Ref. No. .
to-'18 --0 p.t
APPllCATION\~R~rEXTENSION. RENEWAL OR TRANSFER
OF EXISTING PERMIT TO CONSTRUCT SEWAGE DISPOSAL
AND WAfER SUPPLYFAiCI'LITIES FOR SINGLE FAMILY DWELLING
-\,':'0'~ U;:.: :."">.:l'~;:;;~~',,j\ ~":.:" .
~~FER TO'RRVF.RSF. SIDF. OF THIS FORM FOR INSTRUCTIONS
. -,> , '.
PLEASE TYPE OR PRINT LEGIBLY
EXISTING REFERENCE NUMBER
Tax Mao No.
Dist.
1000
Jf\u:.
Sect.
i?-:f
l)A>G IwA
Block
I
Lot
4
NAME OF APPLICANT
name is different from on inal a
1icant, see instructions for transferrin a
"tandcom Jet:c section 6 below.)
MailingAddress J~" jttV~ eD.I~nlj1f:t-t>lo->,.j IlH,,.. Phone{p~/.1''Z~. 3(,(,1
NAMEOFAGENT(Ifnotappli=tj A1- H.? H . ~.".
Mailing Address ~ ...,. ~I.l ~./MILl.Q(. ~'i""l Phone lI:!1J. e;Ze. 'O(.,(,.e,
DATEOFORIGINALAPPROVAL 1/ fJ/ 01.
(If more than 6 years old, a new application will be required.)
TRANSFER OF PERMIT: I hereby transfer all rights and interest in the above referenced permit to the new applicant named
above;
SIGNATURE OF ORIGINAL PERMIT HOLDER/AGENT
PRINT NAME
DATE
MAILING ADDRESS PHONE
Application is hereby made to [ I extend, renew. [ ] transfer for a permit to construct in accordance with Ibis application,
surveys and plans submitted. I hereby certify that I have examined this complete application and the statements therein are Itne and
correct, and that all work sball be done in accordance with all applicable Town, County, State and Federal Laws. "Any false
statement made herein is . hable as a misdemeanor ursuant to S210.45 of New York Slate Penal Law."
Signature of A . cant Date
8. !>. 0(",
Title
1>JIo.$IW'V'I
"u,J~
If you are making Substantial revisions or modifications to a project that has already received a permit to coostroct from the
Department, or it the permit is more than six (6) yearn old, a new application will be required. Renewed permits are subject to any
c es in standards enacted after the a roval date of the ori inal it.
DEPARTMENT USE ONLY
Permit is ExtendedlRenewedffransferred Until -Nilihber of Bedrooms Approved i-
Signature of Department Representative Date '8"- u -C)tr)
WWM-I04(Rev.8/05)
Page I of2
L
..... TARPON DRIVE (50')
pUBLfc:W~T5,R ----------c-___________________
---- -----.-':'"r.: : - --.,..----~:'".,.~-___..__----------__
.,
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.
.
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VACANT
,
,
EDGE OF PAvEMENT
115.~GZl'
1.200 <SAC
SEPTIC TANK
----
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OIJTLET
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.
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.
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'LOT 41
VACANT
I TARPOH DR 'l
~itol.Sl'" .A 2
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~~--------------~~~ II -./1
N iO~ 52' ~~" UJ 115_GZl~' V ;
125,~GZl' i
AI.!.. SURVEY I~Of'\l!MATION PROPOSED CANAL. II
TAKEN Ff'\l!OM SUf'\l!YE'T" (NOT CONSTRUCTED)
F'~F'ARED BY folAWKINe. WEBB
JAEGEFO! A$$OC, F'C. ~
I
~ ~:5ITE. PLAN I
- .~ SCALE. I/Ib" = 1'-0"
GENERAL NOTES
I CON'T'RACTOR SHALL CHECK AND VERIFY AU. CONOITlONS AT THE SITE
PRIOR TO STARTIN& OF /o1C)RK AND HE SH,AU. FAMJUARlZ!; HIM5EL.F /o'ifTH
ilE INTENT OF THESE PLAl6 ANI:1 M,I>JI:;E r40RK A6REE Y'UlH SAME..
2..CCNfR.oloGT~ OR 0I'9iER SHA;L.L OBTAIN A 8UILOTMS PERMIT FROM llE
TOI'fol OF SOI.JTHOL.D PRIOR TO STARllN60 ANT' YiORK.
;, CONTRAcTOR SHALL oeTAIN. AU. REGUIRED ~.AL.5, ~ITS,
cERTlACATES OF OCCUP,A,Nc.'J', INSPEc-TlON AP'PROV'AL5. erc~ FOR ~
PeRPORH3:::> PROM" ~IES HAvING ..J.RlSPrCTlOH ~.
4.ALL ~ 5HA.LL CONFORM TO H.Y.5-. COH51Rl.Jc.TION CODE AND All. F1JA...E
AND flf:6VLATIOHS OF THE TOIf+l OF SCUlHOI.J).
SIP IN nlE" ca..RSE OF WNSTRI.I(;.TlON A c.oNDITlON EXISTS riHlCH
D15A6REE5 Y'41l'H TJi.l\T ~ INDICATED em THESe Pl..AHS. THE COHTRAC-TOR.
SHAU.... STOP.....,RK. AND NOTIFY THE .AoRCHlTEc.T. 5foIOt.t.P He FAIL TO
FOLJ....0r4 'Tl-llS ~ NiO GOHTIt-aJE r1lTli TIE Io'iORK f-E SHAll...
ASSlME NJ.. RESPoNsIBlUTY ANt> LIABILITY .ARf5lHG THERB"'RaM.
t7~[H6 .AROJND N&t CON5lr<J..lCnON 5HAU.. S1-Of'E AriAY AND BlEND INTO
E:XlST1N6. MA..XtMJM Sl..CPE OF AU. ~ AAeAS SHAll. 6E 1,3 AS PER
1lfE TOi"N OF SClI'TMOL..P Pl..At+lIN6 DEPT.
""lCRlHeRCI1H
PINE: TO l€DUol SANe'
~ ",a........__'B_"
\ CANAL. ~~=::"'..;;:;""
~AS9oC..P.G.Al..Eto.
~ ~TE~r-~~~E T DATA
~ ~T~
.......,...."'"
~Cl.Al1!T'I..a'*"
~l.aAHT'c:L....-r'Ey
~ct..\TETs.o.HO
PnHI05lIoeR.'tVB...
::r~~~c;v.TE'I"~
"""fER 1M ~ FOE
="""""'....,
MAP
, AU. FOOTlN6S SHALl.. SEAR ON ~15nJ1:;:SEp SOIL V'{IT'H A MINlp.t,M
. SOIL ElEA.Rft.6 CAPACITY OF 2 TONS F'ER SQ. FT. AND SHAu.. HAVE A MlHIH.IH OF
3'oO-OFc.ovt:'R.
&. ,a.u.., ~ SHALL.. 6E ;3000 PSI MIN. COM::;ReTE 0 2a DAYS.
<t. PROViDe OAMPPF:ooF1NG rilTH TRara.. ON MASTIC ON AU. FOUNDATION
i'lAU.S_
10. Flu.. AND eACKFlLi. MATERIAL oeTAlIED F'F'.Ol-f ~ITE CUT"TlN6
OR !;)(CAVA-nON CR.sa..RGeS LocATEr> NiA'J' FPOM THE GaNS"l'RLIC-TJON
SITE ~), 5HALL BE c.LEA.H~, 6RA.va.. EARTH, OR. A
MIX'TtIRE OF THESe GONTAIHlN6 NO OR6AN1C MATTER I"UTH A MAXlM"M
SIZE OF FC\IR lNOe.
II. CCMPAC.TeD Flu.. t.tUJER SlAB ON 6RAOE ~ ee Ift:LL e.R.ADEO SAND
OR ~. 6R,.I>.,V'EI.. FROt-I SITE OR so...Ra: ~ 6"( ne
ARCHllECT, AND APFRaveD A SUITABLE eeARlN60 MAlER/A!.. FOR
1lfE ~05E Of' 5UPPORTlHSo THE 5l..JloS ON 6R.6IOE MIHIHJM SEARING-
. CAP,Il.CITY TO ee TWO TONS PER SQUARE FOOT.
d:l
z
;::;::
N
1EL. q:14')
EL B.,4'1/".".o'
SLOPE
4'
N
~
4"
4"
8' 0"
3' COLLAR OF SAND
AflD 6RAVEL AROUND
LEACHIN6 POOLS,
TYPICAL
~BROVoIN CLAY\
SANITARY CROSS SE.CTION
fO' 00
'""
--""
DN'<<.~c.LA're1'~
ElAc:IHoII.DAHr" CVoTET" SNO
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1
SEASONAL ~r5H ~reR. LIN:E!l BASeD
ON INP"'O'P,MATION PROVIDED BY ED
OLSeN Of"- THE euR!:AU OF ~
I"tAT'ER RESOU~.
HONlioRlN6 i"\f!W- -5-6101$
LOGA'T"ED ON. THE eAST SIDe! Of'"
RAILROAD ftD.. SOI.Ji'HHOLD.
\"Vlo.'T'!!R a.EV. OP l"El..l.." 5-61015
ON ~T 31, 1<1<1e :: ~
MAXIMUM ~COR:Oa? azvATION
ON MARG-H i, Iq-rq ::: ~
6.54' _ S.T'r' ::: 3:%1' Rise TO MAX
~ ~ HAS ~ AOoa:> TO
ne: ~TER a..evATlON OF o.q' TAKeN
f8ROM PLAN 61"" ~N:$ i"EEB
...lA5:SER A.S5c:)c:.. P.C. FU..E 0 "Too-tle-s,
ON eJCI&.
Qq'. ~2"7'::r 41"T'
4.1" _ seASONAl.. I-IhS+1 cSROlJNO W,olo,~
EL.
63'
~t. i.:g,
DISTRIBUTION <;>
POOL N
/1'-0"---1
EL. 52,'
it SEASONAL
N HI6H i"lATER
EL. 4.1'1'
6ROUND
"'A TER
EL. o.q'
EL. 0.0'
~CLAY \
t-lT5.
I
I
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~.'~
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, n,
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I
., ',.
I .
I
,
I
~~AYATE AND B
--:J^I/. SAND 4 6
I
.,
.1 I
CKFILL
VE~ I
,-, HOLE TO BE SECURED "'ITH
.c: ~ STEEL SHEET PILlN6 DURIN6
. r---- EXCAVATION. HOLE TO BE
., OPENED AND CLOSED IN ONE
.1. ... DAY "'ITH SUPERVISION AT ALL
{ - .. : I TIMES_ HOLE NOT TO BE LEFT
c-. OPEN OVERNIGHT.
-..: I "\. ---..--".. "-1
-, DRl!IHU CLA., ~'M~_ '''--'I'"'!>': '_":'''_'''',';'. .'\
. -"....VATIO. II! I!~.'''P~,,' ";,, ......... '...,;,-",
,I \:..."'" &:911 SANI, ANY :,'("':-;.:;:, . .~
!^lATER IN BRO"'N FINE T'j' HED 5. - EL. -S'ii''HEAlTH C-EPA,':"n;;:!'I~-=.1.'
,
Q
r-
'"
12' DIAMETER
SUFFOLK COUNTY GEPART;;lENT OF HEALTH SEi1V:C;3
PERMIT FOR ApPROVAL OF CONSTRUCTION Fc~ A
SINGLE FAMILY ReSiDENCE AND
I
......."....",
DATE
==....
JO:Vlsr:D'l'06PlOOL.~~
"~HkS+1"""'~
1
PRO...I:cT NO, qcflOO
~
I
I
UEALTU~OEPT. APPROVAL
TbVVN OF SOUTHOLD
st::'T~ - 1000-57-1-4-
I
SITE: PLAN
~B'I'", 11-V
~ATE.. o::-~
SC,&,I",J:, AS KOTW
""""
SP-l
,
_~;:aiP,.qp.....
STEVEN CATALDO
ARCHITECT
1-4 KARl.. A.veLe, 5MI~, N..... U"'l"tn _ (516) '72_214l
e-MAI~ ~ ......"111 ........s. ..-.ol..coH"
incorporated
.
arc h
tects
.
planners
Transmittal
Lauren Standish
Town of Southold
Town HallI Board of Trustees
53095 Route 25/ P.O. Box 1179
Southold, N.Y. 11971
Project Name: DaSilva
From Sylke
Date 09/27/06
Subject SCTM#: 1000-57-1-4
To
Company
Project #
26024
Transmitting
X Herewith
Under Separate Cover
Issued For
Information
Review/Approval
Construction
Record
Quantity
I Description
I
1
1
Authorization Letter
Pennit #5930 (expired)
Check #7051 - $2.50
Remarks:
Lauren,
As per our phone conversation earlier this week please mail us a copy of the Board of Trustees application.
Thanks so much for taking the time to help us out.
Sylke
J:
."
278 NORTH COUNTRY ROAD. P.O. BOX 5220 . MILLER PLACE NY 11764 . (631)928~668 . FAX: (631)928-4151
,
.
.
~.
.
.
.
September 25,2006
Town of South old
Town Hall
53095 Route 25
Southold, N.Y. 11971
Re: DaSilva! 470 Tarpon Dr.! SCTM# 1000-57-1-4
To Whom It May Concern,
A.M. Sutton Associates has been hired by the homeowner, Jack DaSilva, to pursue
permits and file applications in the town of Southold for the above mentioned project.
If there is anything else that you may need please don't hesitate to give us a call.
fred M. Sutton, RA
NCARB Certified
~~
Jack DaSilva
Homeowner
278 NORTH COUNRTY ROAD. P.O. BOX 5220 . MILLER PLACE NY 11764 . (631) 928-8668 . (631) 928-4151
e-mail: amsuttonra@optonline net
SEP-26-2006 1B:52
.
.
P.01
. architects. planners
Fax Transmittal
To: ,..-- Pm"" ..._~J.IM ..-
--
~. Cm/lpmy: ToWlI at SGdboId Date: 09/26106
..-- 1--.---. ,~_... ._-
Fax#: ~1.76S-6641 Phone #: 631-928-8668
.,-.----.----.. ~-,-_.-
/'I'Oj.ctliINt11M: #26024 Fax#: 6310928-4151
. .-
Wltlllber 8 (Jncludi",,71ris One!: 3
.
- -- _.~~~,
---~.- _.- -.--.,-.- ,_. --~".. ~._---_._- . .-
AlltJrorization utur ._. ......_....._--~._."'..-,.~...-.....
.. &pired BotIrd oITrruteu.P.....lt -.- .-- .
.
!4IIretl.
- As per /JIIf' pIrotle _aatiOll earlier todqy aJ/ached pI.as. find the authorization I.//er omf erptred permit 101"
OIl' ell.lIl. Jock DoSliva, for tire property /ocated@ 470 TlJ1'potI Dr.
Ple_ review lhe file omf Ie. me kIIow .mat lhe cost is 10 !rave copi.s 1IU1de QIId mtJI/ed to us. 11 tlrere is OtIythl"8 .Ise
IIrDt Jo"II may t1eed pleo:re give me a call.
71raIIks.
.. ---- -.----. -- ---. .II,
bY&e ...---;--:-.,: ----.;.:-- ,~- F" ,-
.- , .
- -.
,~
SEP 26 ~bb6 -
~
.
"
.-' "
The irIfol'l\l8lion COII18iDed in this lllc9imile m'ilSllllgie ;s intended tor !he use or the individual or entity name above. If you have _
rec:eived Ibis communicalicm if error, please immNI1ately IIOliIY us by telephone and return the original D\eSill3l: to us at the above
acldIeas via U.S. Poslal service. ThaIIk you.
278 NORTH COUNTRY ROAD. P.O. BoX 5220 . MILLl:R PLACE NY 117M ol83111128..e188 . FAX: 183111128...151
SEP-2~-2EliEli6 1 Eli: 54 .
.
P.03
.
arc h
.
September 25, 2006
Town of South old
Town Hall
53095 Route 25
Soulhold, N.Y. 11971
Re: DaSilva/470 Tarpon Dr.! SCI'M/# looo..!57-1-4
To Whom It May Concern,
A.M. Sutton Associates has been hired by the homeowner, Jack DaSilva, to pursue
permits and file applications in the town of Southold for the above mentioned project.
If there is anything else that you may need please don't hesitate to give us a call.
fred M. Sutton, RA
NCARB Certified
~~
Jack DaSilva
Homeowner
278 NORTH COUNRTY ROAD. P.O. BOX 5220. MILLER PLACE NY 11764. (631) 928-8668. (631) 928-4151
a-mall: amsuttonra@oPtonllne net
SE~-:~-2006 10:53 tit
.
P.02
Board Of Southold -Town Trustees
SOUTHOLD. NEW YORK
PERMIT NO.. ..St!J~Q.
ISSUED TO ............~.:A.:~.~...?~_~E..Y-~............
DATE: ...l~t'!>y .?~J....~.Q.04
~ut~nrii!atintt
Pll...uant to the provisions of Chapter 1II5 of the Lews of
the State of New York, 1893; and Chapter 404 of the Lews of the
- St.ta of New York 1952: end the Southold Town Ordinance en-
tHled."REeULA TING AND THE PLACING OF OBSTRUCOONS
IN AND ON TOWN WATERS AND PUBLIC S '/ldfhe
R.EMOVAL OF SAND, GRAVEL' OR. OTHER .Fi.OM
LANDS. UNDER TOWN W A TERS;~. end' a with the
Relolllfion of The Board adopted. e ...M.~y..Jh_...
of .......~.~.i~~.t.~~:'I:..... .... .m...... ...m N. Y. and Illbject to. the
Terms and Condit listed on the revene side hereof,
of Sollthold Town' T OS utkorizes and permi" 1M foRoWln9:
Wetland Permit to con t a ne~ 3.500 sf. single-family
dwelling. with the conditiQn of a non-disturbance buffer 25'
seaward of. the line of hay bales and all as depicted on the
site plan prepared by William Jaeger last dated Feb. 25, 20114.
al In accordance with the detailed IpeclfLCafHlns as presented in
. tha on9lna'lng oppllcetion. .
IN WITNESS WHEREOF. The saId Boerd Of Tl1ISte.. here-
by causes its Corporete Se.l to be affixed, and these prelellts to
be IUliscrlbed by lIlMjorlty of the said Boerd .as of 'kls dat~.
.' 4//,-,-. j'/.;-{. ~ <L-A '7
r ,
.
.
Trustee Inspection File Report
Name ])",-S: lit" . ~\i ^ V
.
Address 'Il:., p (nr... ~-A'
SL f{... I c\
SCTM# '51 - I - +
1st Insp
9/10104
J;jt~c~6:,ft:J.''1s~hn1' N"'~ <
2nd Insp
3'dlnsp
Final Insp
Notes
E
. .
STEVEN CATALDO AlA. ARCHITECT
14 KARL AVENUE, SMITHTOWN, NEW YORK 117B7. (631) 724-2141 FAX (631) 724-0407
E-MAIL: SCARCH@OPTONLlNE.NET
June 15,2004
Board of Town Trustees
Town of South old
53095 Route 25
Southold, New York 11971
Att: Lauren
Re: Jack DaSilva Residence
Tarpon Drive,
Southold, NY
S.C.T.M.: 1000-57-1-4
Dear Lauren;
As per your letter or approval from meeting of 5-26-04 enclosed is a check for the
amount of One Hundred Dollars. ($ 100.00).
Thank you for your assistance with this project, and if you need any additional
information please do not hesitate to contact me.
Sincerely;
I}
./~~
Assunta Cosentino
Steven Cataldo ATA.U
-=
.
fB)~ ~ ~ ~ 'W ~ rR\
\n1. E~M~ 2 1 2004 11>>
Soulhold loY/n
Board of Trustees
Albert J. Krupski, presiden.
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
.
Town Hall
53095 Route 25
P.O. Box 1179
Southol~, 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.
/)a...
s; {~
INSPECTION SCHEDULE
~ Pre-construction, hay bale line
1 sl day of construction
Y, constructed
~ Project complete, compliance inspection.
Board Of Southold .Town Trustees
SOUTHOLD, NEW YORK
PERMIT NO. ...5'13Q.
ISSUED TO .m..m...!.:.\~.~.J?~.?.F:'Y.~m.n.
DATE: ...11"y.?6......?9.04
...................................... ....On......
1\ut~nrilatinu
Pur5uant to the provi5ion5 of Chapter 615 of the LaW5 of
the State of New York, 1893; and Chapter 404 of the LaW5 of the
. State of New York 1952; and the Southold Town Ordinance en-
fHle<r"REGUtATlNG-A-ND.THEcPLA.€tNG,GF-GBSTRUGJIONS-
IN AND ON TOWN WATERS AND PUBLIC LANDS and~the
REMOVAL OF SAND, GRAVEL OR OTHER MATERIALS.f.B..OM
~~~;~[~~~Y:~~;~::~l~ji~
of m....~[J).i!J:.t.?~.":..h.hn . hhh' N. Y. and 5ubjeet to the
Terms and Conditio s ed n the reverse 51de hereof,
of Southold Town T s authorIzes and permits the following:
Wetland Permit to cons uc a new 3.500 sf. single-family
1 dwelling. with the condl of a non-disturbance buffer 25'
seaward of. the line of hay bales and all as depicted on the
site plan prepared by William Jaeger last dated Feb. 25. 200"4.
aU inaeeordanee with the detailed 5peeifieations as pre5ented in
. the originating apprlC4tion. .
IN WITNESS WHEREOF, The 5aid Board Of Trustees here-
by eaU5e5 its Corporate Seal to be affixed, and the5e presents to
be subsen'bed by a . majority of the said Board as of this dat.e.
~fi4A >.'7. ~, '~J0?
e , /
.
.
TERMS end CONDITIQNS
Jack DaSilva .
ne Per~
~at 5 Cake Walk Terrace, Smithtown '" '. N. y~ IS..
fa"' of the coosidaatioa lor the 15<-........ of the Pe.aait cIoes ....taod &ad pl'e$Cribe to the fot"
towing:
1. That the saidlloatd of Trustees and the Town of Soutbold are released.from any and
af1 damages, or dalms for damages, of IUils ~. clitecdy or io.direc:dy as a result of any opec-
.....tIon pedormedl"''IU'at~..tbls..l'NWlt...a.I!!!..~~.~_~~.~~_~.bfs~QC_~~Q.W!I, ~....
defendaoy and af1 IUd> sWts'ln1tl.u.lby diird.,atties, and the said p....,.;"H ~ fallllabl1ity
with reSpect thereto, fQ.th~rleteexdusion of the Iloud of Trustees of the Town of ~
. 2. Thatfd4f~.,..I'Is. '~d for a.period of . 24Il105. wIWh.Js ~lIcd to be the
estimated ~.Jci :~,., to~~letc ~,wodc la'nllwd, butihoald ~ wamor, request
lor an _oll ~!~~ oia~Jto;~ ~ at a .~ ~ . .
.' 3. That this ~ '~<!Ik ~ll,?<ierUlitc1J. or as loog IS the ~ P-mee .wlshCs .
to . mol.....n the SUUCQl[e or (rQject ~o.l~ to proYtlle evidence to anyone macemcd chat tDtb-
~don was origiaally obtalaed. . b'. 7'. .i
,.; ,.
(. That the work iavolved Wlllbe lUbject..to ~ and approval of ibc Board or
Its agents, and llOCl-<Xllllp1laoce with the provisioJlS}>> -'the Of'lgl....li'lg application, maybe CIllSC lor
mocation of this Pumit by ~l\ltioo of the said 1loatd.
S. That there will be no unteosoo.b1e Iotedercooe with aavlgatloo as a result of the wod<
hereIo auiborized. . .
'6. That there sha1I be 00 Iotedcreaoe with the right of the public to pass and epass a10ag
cbe beach betweeo fI/gb' and low water marb. .
7. That if fucure opewioas of the Town of Soath9Id RqUb che.l'aIlOftl ud/or alteratioGs
in the 10Cl'flnn of1bc wod< baeIoa.adIO~'[ ~ or if, in the 0(1I0I0a of die >>oua of r-. the .
wodtshall cause IIllmSOllllb1e obsttucbOa to ftee oav/gltloo, cbe said PemIlttee will be recpJrccI.
apoo.due notice, to remove'or alter this wodc or project hercIo stated wilI>o\lt ~ to the T_
. of Sol1thold. . .
. 8. That the said Board will be oodfacd by the Permlttce ot the cOmp1edoo. of the wodc auth-
orized.
9. That the .........,_ will dJtaIo. af1 ocher permia alld ............ 6at may be requited q>;
. pfcmrn'" to this permit ~ may'be sabject to revo!<e apoo. UlIare to obca1n I8IDe.
.
.,:!
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Albert J. Krupski, President .
James King, Vice-Preside~t
Artie Foster
Ken Poliwoda
PeggyA 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
May 26, 2004
Steven Cataldo, AlA
14 Karl Ave.
Smithtown, NY 11787
RE: JACK DASILVA
470 TARPON DR., SOUTHOLD
SCTM#57.1-4
E'f.P l'(Z.~
~
Dear Mr. Cataldo:
The Board of Town Trustees took the following action during its regular meeting held on
Wednesday, May 26, 2004 regarding the above matter:
WHEREAS, Steven Cataldo on behalf of JACK DASILVA 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 March 8, 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 May 26, 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,
I>
--.
7'
2
.
.
WHEREAS, the Board has determined that the project as proposed will noU:lffect the
health, safety and general welfare of the people of the town,
NOW THEREFORE BE IT,
RESOLVED, that the Board ofTrustees approve the application of JACK DASILVA to
construct a new 3,500 sf. single-family dwelling, with the condition of a 25' non-
disturbance buffer seaward of the line of hay bales and all as depicted on the site plan
prepared by William Jaeger last dated February 25, 2005.
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: $100.00
Very truly yours,
JL&~-.$ 0. ~. '19<A-J.: t}. .
Albert J. Krupt'ki: Jr.
President, Board of Trustees
AJK/lms
~
.
.
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
TO: -'net frlSi\ua
Please be advised that your application dated 3\ ~l eI-j
reviewed by this Board at the regular meeting of S1~/()I.(
following action was taken:
has been
and the
( ./) Application Approved (see below)
L-) Application Denied (see below)
L-) 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:
J!:5D.CSb ~ P (~-( ~~"\)u,,\ ~u.'od.\a. \~ tn':l~eL-\iUr)
~ ~ll3J~ -\1ro\ lC\S\leetiiY)
TOTAL FEES DUE: $ IOO,Df)
SIGNED:
~~$ 9. ~'(j..
PRESIOENT, 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, April
13,2004, the following recommendation was made:
JACK DA SILVA to construct a new 3,500 sf. single-family dwelling.
Located: 470 Tarpon Dr., Southold. SCTM#57-1-4
The CAC did not make an inspection, however the Council recommends a 20' non-
disturbance buffer between the house and the wetlands.
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Transmittal
Lauren Standish
Town of Southold
Town Hall! Board of Trustees
53095 Route 251 P.O. Box 1179
Soutbold, NY. 11971-0959
Project Name: DaSilva Residence
Transmitting X Herewith
To
Company
From
Date
Subject
Sylke K Schade
04/03/07
SCTM#: 1000-57-1-4
Project #
26024
Under Separate Cover
Issued Far
Information
Review/Approval
Construction
Record
Quantity
I Description
1
1
2
Copy of Town of Southold's transmittal wI request for revisions
Check #2058 - $100.00
Revised Surveys
Remarks:
Note:
APR - 4 2007
278 NORTH COUNTRY ROAD. P.O. BOX 5220 . MILLER PLACE NY 11784 . (631~ 928~668 . FAX: (631) 928-4151
.
.
MAILING ADDRESS:
P.O. Box 1179
Southold, NY 11971
PLANNING BOARD MEMBERS
JERlLYN B. WOODHOUSE
Chair.
KENNETH L. EDWARDS
MARTIN H. SIDOR
GEORGE D. SOLOMON
JOSEPH L. TOWNSEND
OFFICE WCATION:
Town Hall Annex
54375 State Route 25
(cor. Main Rd. & Youngs Ave.)
Southold, NY
Telephone: 631 765-1938
Fax: 631 765-3136
PLANNING BOARD OFFICE
TOWN OF SOUTHOLD
To:
Jim King, President
Town of Southold Board of Trustees
DEe 1 2 20%
From: Mark Terry, Senior Environmental Planner
L WRP Coordinator
Date: December 6, 2006
Re: Proposed Wetland Permit for Dasilva
SCTM#1000-57-1-4
JACK DASIL VA requests a Wetland Permit to construct a two-story 3500 sf. single-family dwelling.
Located: 470 Tarpon Dr., Southold. SCTM#57-1-4
The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of
Southold Town Code and the Local Waterfront Revitalization Program (L WRP) Policy Standards. Based
upon the information provided on the L WRP Consistency Assessment Form submitted to this department,
as well as the records available to me, it is my recommendation that the proposed action is
CONSISTENT with the Policy Standards and therefore is CONSISTENT with the L WRP provided that
the applicant provide evidence that the proposed action will not result in the any adverse impacts to
the adjacent properties due to flooding..
I. The proposal does not fullv support Policv 4.1 "Minimize losses of human life and structures
from flooding and erosion hazards." The following management measures to minimize losses
of human life and structures from flooding and erosion hazards are recommended:
A. Minimize potential loss and damalle bv locatinll development and structures awav
from floodinll and erosion hazards.
In addition to further Policv 5 it is recommended that the Board require the following best management
practices:
I. Require native landscaping to minimize irrigation and fertilizer applications.
2. Require a large non-disturbance buffer adiacent to the wetland to preserve the quality of
wetlands.
Pursuant to Chapter 268, the Board shall consider this recommendation in preparing its written
determination regarding the consistency of the proposed action.
,[
<
..
..
I
James F. King, President
Jill M. Doherty, Vice. President
Peggy A. Dickerson
Dave Bergen
John Holzapfel
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
NO'V - 4
..... ',-
b.;~J
Office Use Only
_Coastal Erosion Permit Application
./Wetland Permit Application. _ Administrative Permit
Amendment/Transfer/Extension
/Received Application: 1J141oY
---- Received Fee:$ ,1(S\)
...c:Completed Application III '11 Q\.
_Incomplete
_SEQRA Classification:
Type I_Type 11_ Unlisted_
_ Coordination:( date sent)
~RP Consistency Assessment Form J 1/410.10
--€AC Referral Sent:J1l ~ I'l\h
~te onnspection: ~Ct lOt.
_Receipt ofCAC Repo :
_Lead Agency Determination:_
Technical Review:
~ublic HearingHe~
Resolution:
- LW~fv
Name of Applicant JAC-lC. -PA.~I LVA
Address_/?/P IJI$S"EaLl()qlJ~ !Zn'E"L 120, I ~m-l1.lt~wiJ
ll.'( 11"1101- PhoneNumber:((P!H 1"2"1- ~CI"J
Suffolk County Tax Map Number: 1000 - 1?'T' \- ~
Property Location: I-J-:fv -tkefr'1-I bt.. , ~Ol..4tH Dl.O
~1.~ I ~A"~ HA-tL.A j2:'Q. (" .rt.. z...)
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: A.M. ~~~ As...o~.
(If applicable)
c~
9- ~ \\\l:/)
\\
Address:
'Z1-~ t.J. UlI..llJ~ !Zo. .1111-u.-.e. ~ ~_
Phone: V 1.,. <=f~. !:>/PlP I!I
\I11s>Lt
-,
4It Board of Trustees APPl~ion
GENERAL DATA
Land Area (in squarefeet): '20, lZ,c;;. -G.f.
Area Zoning: ~-L-\o (~<!.II?~J
Previous use of property:'" A~ +
Intended use of property: ~Ull.O Z ~"'1' ~HqL-f:" ~IU(
l)!lJn,vu....\,
Prior permits/approvals for site improvements:
Agency
Date
....1:,- ~te 1). ~ .c,...
1M'* tIO-'f'b-OI"tt..) 'blo/p
(1- '"l-a~ -OZO"~ /~O()I) e/f/IO'!::> k'"'") \
( l!?tpl/l...t't'<'H ~ 0/tJlo'i>)
_ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspemjed by a governmental agency?
,/ No Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
~1[...D lJeoJ Z~. ~~/1ll ~'f' ~IHqL.r
~1I"i 1)!lJt:U.lLI'I
~ Board of Trustees APP1~ion
.'
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
GMlLO '2. *IU(. J.Goo S'f SIl..J~lvr ~'9l?nI~
o square feet
Area of wetlands on lot:
Percent coverage oflol:
lib %
Closest distance between nearest existing structure and upland
edge of wetlands: IJ/A feet
Closest distance between nearest proposed structure and upland
edge of wetlands: t::fo' feet
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? ::f ~ 1. (p
cubic yards
Depth of which material will be removed or deposited:
~I
feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
\J~ l)? J..bt_~(l.~ /\-tAl'
W~ / t>~c.
V fJ<4 0 -h 4.-
PlfU11 t
~. 'U. O~
, IIfJA-c.{"' 01.4 {loA'\.
J:f 1.L..j1-~~~020qf/OOOI
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by
reason ofSuch proposed operations (use attachments if appropriate):
4It Board of Trustees APPli~ion
.
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
(!,u11..M? z.~fZ.l.( \ ~~OO 6.f. 511.-lq~~'~~IOLnJc4
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? 1 '1'1. to
( cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
~ Pf'}U1't ~ 1- 41'!'co - O'Zo"l"'T / 000 I
(VjlMt7..pIA.- CU.~.blO)
DEC-20-2006 11:13 P",
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DEC-2B-2B06 11:12 p~
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P.02
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name:
Address:
P.O. ~x 3",,"0, ~DU~UO, ~~ 0''''/
6~~LO ~lfoetl!..q~lJp, lil,-,.
STATE OF NEW YORK
COUNTY OF SUFFOLK
A1-~ t1. ~101-l . residing at "'~. U\.I~ lib.
I111.U1..JI'iAaI ~'i' 1I'1t..", being duly sworn, deposes and says that on the
I/A day of 1Xt.. , 20 J!!l, 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 Notic ra mailed at the United States Post
Office at r1, 1,.L.tJC.. pt..k..Cl , that said Notie er ailed to e of said persons by
(certified) (registered) mail.
lAUREL l.AM"I'ON
Noto,y PuNobl~ Sr.," 01 New YorIl
. ., .4802898
~LX)Ic.f(!d I /"j :{v{'~kc.u..
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DEC-20-2006 11:12 p~
.
P.01
incorporated. arehi teets. planners
Fax Transmittal
1--.. To: 1"1'011/' SJlke
.-- f--..-..'-= "'...~-~..-. -.----.--.-
COIllJldllY: Ton of SoudIoIdllIoanIlIl TraIIeeI Date: \2120106
.....-
Fax#: ,,31.76s-664\ Phon. #: 631-928-8668
~,,- .-. - ..---
I Proiectfll Name: 1126024 Fax#: 631.928-41'1
- --. . -..-..-
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_.~'.._.- ........ .- ..-..---
u_..,._ -~-, - .-.....,
Proof of MIIIllllJl..JllNt1IictI Ct!rtIIled Mail ~.._ ~.... u___. ....
,
1&: JflCk lJ&Yillv
470 TtIIfJOft ~
SCI'M#: 1(J(J()..S7-1-4
Hetlrill/llhtte: 1/24107
TIM: ioformatiou contained in this llIcsimile -'''8'' i. ;ntonded for the UGe of the iDdIvidua1 or enti~ name lIllo.e. If you have
IeC:eived this QOIIIlIIUI1jcation if error, please im'lledla1eiy notifY US by telephone and retunllbe origina1 m-""8" to US at Ibe aIlcl\IIl
addrcia vla U.S. Posla1 seM<:e. Thank you.
278 NORTH COUNTRY ROAD. P.O. BOX &220 . MILLER PLACE NY 11784 . (831) 928-l1l181l . FAX: (831)928-4151
DEC-06-2006 02:19
AMe
.
P.01
corporated. architects. planners
Fax Transmittal
~'---
...!/rtme #: .___
Fax#:
-~--------_.-
IZIO~____..__.__
631-928-8668
631.923-4151
--~-------'
To:
___ .from.:
[)DIe:
.--.-
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..-.--------....---...--.--.-.----
AffldlMtof~--..----.--__-._--.-,
/'rorJfNM,qill!!/fJ!.{Jfodcel ~Mqil ~-----_.
------~----
Re:
Jtlt:k DoSiIYG
470 Tarpon Drive
SCTMI#: 1000.57.1-4
. "
DEe - 5 2006
H-uw lJDte: 11/13106
The iDlbl'llllldon l;Ontalncd in this 1iH:silIIilc IIlelllIllge is intended fur the use of the indivi or entiIy 1UIIIIll~. If you baYe
received tbis COlIllIIUIIlcation if error, please ilmnedialely notity us by telepl\oJle and return original W""""8" to us at the above
addJas via U.S. Postal scMa:, Thank you.
218 NORTH COUNTRY ROAD. P.O. BOX 1220 . MILLER PLACE NY 11784 . (831 8~888 . FAX: (831) 828-4181
..~:.C.::!,.6-2006 02: 19 "M.
.
P.02
Jame. F. KIng. President
Jill M. Doherty. Vice.Presldent
Peggy A. Dickerson
Dave Be1'g9n
Town Hall
63096 Route 25
P.O. Box 1179
Southold. New York 11971-0959
Telephone (631) 766.1892
F8X(831)766~1
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
BOARD OF TRUSTEES: TOWN OF SOUTHOLD
----~-----------------------------_._------------------------_.
In the Matter of the Application
of
_______~~Jt.--~~CJlJL~-----------------------
COUNTY OF SUFFOLK)
STATE OF NEW YORK)
AFFIDA VIr OF POSTING
I, At.Ff...f1:;:l n. 6~ residing at '2'T'l; \J. .:::.....~ ~
nlL.l.~ P~. ""'~. 11"'I'c..lf
being duly sworn, depose and say:
d
. That on the I day of 'J:)~~ . 20cx", I personally posted the property known as
1:lA"Il....Pt- 4."", ~lA DI(,,(II~
by placing the Board of Trustees official poster where it can easily be seen, and that I have
checked to be sure the poster has remained in place for eight days prior to the date of the public
hearing. Date of hearing noted thereon to be held J
" 0'10 b 1 (,;.30 pm,
Dated:
Sworn to before me this
&"'dayofl>~~fj&
NollI>y l.AUflEL lAMPfON
~bI~1 St.,. 0' "ow.......
^ r' ~ -480281/8 .....
1.f"t1(I,,1/d r" )~k ('k.-
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DEC-06-2006 02:20 AM.
.
P.0a:
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
STATE OF NEW YORK
COUNTY OF SUFFOLK
~ M, Suf't1l'1-/ ,residingat z"a ~. t.olA~ ~
MIl.L"- plJlG4" I-Jl:{. II"'IV". being duly sworn, deposes and says that on the
"I day of l>r:t.. . 20ft, deponent mailed a true copy of the Notice
set forth. in the Board of Trustees Application, directed to each oithe 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 oftha Town of South old; that said Notices e mailed at the United States Post
Office at PoJU- J~D"" , that said Notices ere 'led to each aid persons by
(certified) (registered) mail.
Name:
~kt1' u.+lll'Vlf.\"l1'
1;:>ro.J.JA aJo lf1'tl ~" .
~trfr'lDIA.e. /!.Jt4i'\'r'1Pn-l
~~ 'PltVlJ'lA'f'r1.....r
~L- j:'\l,.lpIt.oW51L1
~1~A-ItD I'l""-
Address:
p... {!.QlI "11"i . ~oc..fHl'l.O 1-01'( llnl
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No. ~'.<1802_
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PROJECT 10 NUMBER
617.20.
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Only
(To be completed by Applicant or Project Sponsor)
SEQR
,r
PART 1 . PROJECT INFORMATION
1. APPLICANT I SPONSOR
A.r1. ~....., A~sOv.
2. PROJECT NAME
1>A~'L.-VA 1te-~IOeU~
UI"'llr
l~ v' V
"
...., !..-o.;l,,j
3.PROJECT LOCATION:
Municipality SOLl-f1W1AO County -:;(...i t.-tL
4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete. or provide map
J-i"fo ~Di-l "1>"--'1"'" /-Z'Z-t?' ~st Or nmu IZ-t;::> (s.~. 1.<7)/
5out'tl ?It? ~ Of -1A,tpoL-l ~\le
5. IS PROPOSED ACTION: ID New
D Expansion D Modification I alteration
6. DESCRIBE PROJECT BRIEFLY:
Cokl~t z. ~rvy I ~~OO '&-f S,t.A4!-e-
fA-r11L-1 'l)tJ ~1t....l1
7. AMOUNT OF LAND AFFECTED:
Initially ....,(p acres Ultimately. ~ C, acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~ Yes 0 No If no, describe briefly:
2:.JtiAT IS PRESENT LAND USE IN VICINITY
~ Residential 0 Industrial o Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture D Park I Forest I Open Space
OOther (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
~CY (Federal, State or Local)
~Yes D No If yes, list agency name and permit I approval:
1'"ow l-A "f ~O .:'LO( /!;;;<..H V?IU 'Dq?t)
11~S ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
IYIYes DNa If yes, list agency name and permit I approval:
~'" I. "l1-:!7cb . (''2041-/ &'&' c> I ';;;t+\1? re. 10 - "1'0. 01 '-f(p
-
12. AS A ~LT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
Ges lIlJ No
I CERTIFY T T THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
, ~.A. Dale: lof'J'i Jo(P
Signature
If th ction is a al Area, and you are a state agency,
e Coastal Assessment Form before proceeding with this assessment
~-~
" )
.
.
/~
PART II - IMPACT ASSESSMENT (To be cornoleted bv Lead Agencvl
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF.
DYes DNa
B. Will ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
o Yes DNa
c. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
I . JI
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
I I
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
L . I
C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly:
I ." I
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
I -.--- .----- -------- ..~ ------ , ---- ------ .- 1
C6. long term, short term, cumulative, or other effects not identified in C1.C5? Explain briefly: .
I I
C7. Other imoacts (including changes in use of either quantity or tvpe of energy? Explain briefly:
I I
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: i
o Yes 0 No I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explam
o Yes ONO I :1
---
PART 111- DETERMINATION OF SIGNIFICANCE (To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or otherwise significant. Each
effect should be assessed in connection with its (a) setting (Le. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e)
geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes, the determination of significance must evaluate the potential impactofthe proposed action on the environmental characteristics of the CEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL
EAF and/or prepare a positive declaration.
Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actio
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi
determination.
Name of Lead Agency
Date
Pnnt or Type Name of ResponSible Officer In lead Agency
Title of Responsible Officer
Signature of Responsible Officer in lead Agency
Signature of Preparer (If different from responsible officer)
4It Board of Trustees App1ltation
County of Suffolk
State of New York
JItttL "DA S II. IIA 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 IllSIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN TillS 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 TillS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF TIllS APPLICATION.
'/
~&l ,20-0(0
SWORN TO BEFORE ME TIllS~DAY OF
LAURel LAMPTON
NoIary Public. Stale.ol N_ Yort
No. 31-4802898
Comml8alonExpires .l'Z/~yoi..
4It Board of Trustees APp~tion
AUTHORIZATION
(where the applicant is not the owner)
...
I,
J~ 1)1161 \.V A:
(print owner of property)
residing at I:,(p. I-lI~eCi'I..tO;""'~
(mailing address)
I:'-tva ~ josn ~,..,L...l uy- 11""i.t;l1-do hereby authorize
(Agent)
A.M. ~ttoLJ A~s.of/.
to apply for permit{s) from the
Southold Board of Town Trustees on my behalf.
8
.
.
APPLICANT/AGENTntEPRESENTATfVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emo]ovees. The DUmose of
this ronn is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is
necessary to avoid same. '
YOUR NAME:
GCAft"'N I A1,..~ 1"1. ... ..
(Last name, first name,-1}1iddle initial, up.less yo'u are applying in the name of
someone else or other entity, such as a company. Ifso, indicate. the. other
person's or company's name.) -0.
NAME OF APPLICA nON: (Check all that apply.)
Tax grievance Building-l.
Variance Trustee
Change of Zone Coastal Erosion
Approvai of pi at Mooring
Exemption from plat or official map Planning
Other
(If "Other", name the activity.) /!;oJ>rnn O~~ ~ 't
Do you personally (or through your company. spouse, sibling, parent, or child) have a relationship with any officer or employee
of the Town QfSouth~]d? "Relationship" includes by blood, marriage, or bus'iness interest. "Busine~ interest'? means a business,
including a partnership, in which the town officer or employee has even it partial ownership of (or employment by) a corporation
in which the town officer or employee owns more than 5% of the shares.
/'
YES
NO
If you answered "YES", complete the balance of this form and date and sign where indic'!-ted.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself(the applicant/agent/representative) and the town o.mcer or employee. Either check
the appropriate line A) through D) and/or descri,be in the space provided.
The town officer or employee or his or her spouse, sibling, pare!1t. ot 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 -beneficial own~r of any interest in a non-<:orporate entity (when the
applicant is not a corporation); .
_C) an officer, director, partner, or employee of the applicant; or
_D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS I
200 !)1
Town of South old
.
.
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. All applicants for perrnits* including Town of Southold agencies, shall complete this CCAF for
proposed actions that are subject to the Town of South old Waterfront Consistency Review Law. This
assessment is intended to supplement other information used by a Town of Southold agency in
making a determination of consistency. * Except minor exempt actions including Building Permits
and other ministerial permits not located within the Coastal Erosion HazqrrFAreaJ, 2G03
2. Before answering the questions in Section C, the preparer of this form should review the exempt
minor action list, policies and explanations of each policy contained in the Town of Southold Local
Waterfront Revitalization Program. A proposed action will be evaluated as to its significant
beneficial and adverse effects upon the coastal area (which includes all of South old Town).
3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will
affect the achievement of the L WRP policy standards and conditions contained in the consistency
review law. Thus. each answer must be explained in detail. listinl!: both supporting and non-
supportinl!: facts. If an action cannot be certified as consistent with the L WRP policy standards and
conditions, it shall not be undertaken.
A copy of the L WRP is available in the following places: online at the Town of Southold ' s
website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all
local libraries and the Town Clerk's office.
B. DESCRIPTION OF SITE AND PROPOSED ACTION
SCTM# ?1-
I
J./
PROJECT NAME "DA $1 I.. V y;. 1t1!"-';.1 PpJ~
The Application has been submitted to (check appropriate response):
Town Board 0 Planning Board 0 Building Dept. 0 Board of Trustees ~
1. Category of Town of South old agency action (check appropriateresponse):
(a)
Action undertaken directly by Town agency (e.g. capital
construction, planning activity, agency regulation, land transaction)
o
o
(b) Financial assistance (e.g. grant, loan, subsidy)
(c)
Permit, approval, license, certification:
B
Nature and extent of action:
GA:>U~c..-r Z ~1tJ . ~1L-l~, L-f' ' :l>~ 00 ~F IZesIOcnJ~
lH tz.-L/o ~ M~
.
.
1"~a..I l)t..jzze:,,' ~s~
Ir'1Z- ~~
n~L-/
~.(-6.f..z~)
Location of action: Li"h
Site acreage: . '1 (p
Present land use: VAt-ANt
Present zoning classification: te-4o
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant: k. t1. 6~..J A,=,<>oc,.
(b) Mailing address: '2"'"111 /J. t-o/)~ 'f1t1' w. / p.o. e>Ol( c;nO
MI!Nt:!'- 17~. a.J. '( 1171P t.f
(c) Telephone number: Area Code ( ) UbI. "I~. f>"c, '0
(d) Application number, if any:
Will the action be directly undertaken, require funding, or approval by a state or federal agency?
Yes G1 No D If yes, which state or federal agency? 1)~ c.. '
~'\t ~ 1.1f1~~_oZ,O"l1l "001
C. Evaluate the project to the following policies by analyzing how the project will further support or
not support the policies. Provide all proposed Best Management Practices that will further each policy.
Incomplete answers will require that the form be returned for completion.
DEVELOPED COAST POLICY
Policy 1. Foster a pattern of development in the Town of South old that enhances community character,
preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and
minimizes adverse effects of development. See L WRP Section III - Policies; Page 2 for evaluation
criteria.
DYes D No ~ Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
L WRP Section III - Policies Pages 3 through 6 for evaluation criteria
DYes D No c1 Not Applicable
.
.
Attach additional sheets if necessary
Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See
LWRP Section In - Policies Pages 6 through 7 for evaluation criteria
DYes 0 No G1 Not Applicable
Attach additional sheets if necessary
NATURAL COAST POLICIES
Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP
Section III - Policies Pages 8 through 16 for evaluation criteria
DYes 0 No [2( Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See L WRP Section III
- Policies Pages 16 through 21 for evaluation criteria
DYes 0 No GNot Applicable
Attach additional sheets if necessary
Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including
Significant Coastal Fish and Wildlife Habitats and wetlands. See L WRP Section III - Policies; Pages 22
through 32 for evaluation criteria.
o 0 ~
Yes
No
_APPlicable
.
Attach additional sheets if necessary
Policy 7. Protect and improve air quality in the Town of South old. See LWRP Section III - Policies
Pages 32 through 34 for evaluation criteria.
DYes D NoGj Not Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wastes. See L WRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
DYes D No 0 Not Applicable
PUBLIC COAST POLICIES
Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public
resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation
criteria.
DYeD Noc6 Not Applicable
Attach additional sheets if necessary
WORKING COAST POtlIES
.
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See L WRP Section 111- Policies; Pages 47 through 56 for evaluation criteria.
DYes 0 No [21 Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
DYes 0 No G Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See L WRP Section III - Policies; Pages
62 through 65 for evaluation criteria.
DYes 0 No0 Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Policies; Pages 65 through 68 for evaluation criteria.
DYes 0 No 0 Not Applicable
PREPARED B
TITLEh.clh.rf::t'r DATE 10. Zt.j .O(p
~~;:;;,~-
incorporated
.
arc h
tects
.
planners
Transmittal
Lauren Standish
Town of Southold
Town Hall! Board of Trustees
53095 Route 25/ P.O. Box 1179
Southold, N.Y. 11971-0959
Project Name: DaSilva Residence
To
Company
From Sylke K Scbade
Date 11102106
Subject SCfM#: 1000-57-1-4
Project #
26024
Transmitting
X Herewith
Under Separate Cover
Issued For
Information
Review/Approval
Construction
Record
Quantity
I Description
3
3
3
I
3
3
3
3
Board of Town Trustees Application
LWRP Consistency Assessment Form (authorization & transactional disclosure)
SEAF
Check #1938 - $250.00
SCHD permit (RIO-98~146)
NYSDEC permit (1-4 738~2097/00oo I)
Expired Permit #5930
Survey
Remarks:
,,",:"
NO\) - 4 2~uj
Note: Board of Southold Town Trustees, Permit #5930, dated 5/26/04 bas expired.
No work bas be2un on the site and there are no cbanl!es to the proposed work.
278 NORTH COUNTRY ROAD. P.O. BOX 5220 . MILLER PLACE NY 11764 . (631) 928.a668 . FAX: (631) 928-4151
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
Fax (631) 765-1366
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Application
~etland Permit Application ,- Major
Waiver/ Amendment/Chanfteq
....Received Application_'.31 & 0
-Received Fee:$ ~ . .. _
,completed Application 3/ifoll'
_Incomplete ",n re ~
_SEQRA Classification: 0 ~ ~ ~ q \"I U;
Type I_Type II_Unlisted
_ Comd""",,,,(d",' "'0 \6l, R _ 8 """ D
-CAC Referral Sent:' \~ MA
~ate ofInspection:
_Receipt ofCAC Report:
_Lead Agency Determination:
Technical Review:
,.....public Hearing Held.J1 ~I JOV
_Resolution:
Minor
sou\nold iown
Boar. otiruslees
Name of Applicant ..\A.c:...l"- DASILYA.
Address
s ~ 6.\<~' v-.J.6.L ~ .~~ 12 ~ h.c-C
C.ILA I-r-u.,-n VVr-...1
N Ev-J ynl? '" " 7 9.,7 Phone Number:(OP 724 . ,'lce. J
iIJ
r:s: (OJ \~
~0\~
Suffolk County Tax Map Number 1000 - 5 1- 1- 4
1\,\0
Property Location: IAR -p ol-J De \oJ;;;::-. c..nu-/"'I-i OLD
(provide LILCO Pole #, distance to cross streets, and location)
AGENT: 'S.-r", VC I" C ^-r Ll.L 1)-0 A I r...
(If applicable)
Address: \ 4.\<.. A ~ l-.
Avre., 61-A1-r-1...-rO\N.....,, ....Iy. 11"1'B1
Phone ~3J\ 724-7 I'll
/
4Ibard of Trustees APPlicat~
GENERAL DATA
Land Area (in square feet):
20../1.';. ~q:> 1=,
Area Zoning:
1<-:t.. <; I Dr;;:. ........,4......
Previous use of property:
,/;>c.. ~J.. J-r
Intended use of property:
Rc: So IDG:: ..J-n ....L
'TO BIJ'l l~
A ~.....Ic...l iF "F""".c.....I-.Alt..., .~(",-)h.A~
Prior permits/approvals for site improvements:
Agency
Date
Sc:.. Dcep-r of /-f€.4t-rH
A-~ -02..
DC c..
Pl-' 1- 0"
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 expJanation:-
Project Description (use attachments if necessary):
r ON 'S;.-r-t2..ltr'1'"' ;t)hJ
o-F j..Jt::"vV 3sno SCj> r--r-
~I"-'r~' t;; P""".......I'-r
,~ ~ oS j OE:: J>.lLP-
4Itard of Trustees APPlicati~
WETLAND/TRUSTEE LANDS APPLICA nON DATA
Purpose of the proposed operations:
~ nAl s-r12 .<1,-- -r IC':l....J ,.., 'F So J ,J,,"., or. ..:-""" '-" / / '-1
~~5'D1t;;. 1o.1c:..g::;:
Area of wetlands on lot:
o
square feet
Percent coverage of lot:
If)
%
Closest distance between nearest existing structure and upland
edge of wetlands: i'.J J A.. feet
.
Closest distance between nearest proposed structure and upland
edge ofwetlands:_:ltJ I feet
Does the proj ect involve excavation or filling?
No
./
Yes
If yes, how much material will be excavated?
cubic yards
How much material will be filled? l'"J4'!. ~
cubic yards
Depth of which material will be removed or deposited:
31
feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
"'-Ie;: DO. NO"-
'FoOl: c: 5,EZ;:
.0.......'1 I......""A.C~ OIL
crFtLC-~ ~.,,,I 1'1"""" 'vV.o;c-r-...........Jos
el 'TJ DA&....
V/.l.~r<..s.
OF -n..i,-:;:; -rnwl\./ A" A.. IU;Su 1-.... oF"
c:.O~Srl"$t."'(.:1' /0...) O'l" e""~ F",","",,,,-f 1'\.~~I.o""Nc;,.""
~ard of Trustees APplicat~
COASTAL EROSION APPLICA nON DATA
Purposes of proposed activity: c::. e:H I ~.;-r Ii:: ,H.d"' I oN (') 1"
~'tl..lt""-L~
r-o..4-.A ( l,--,
1o'<~~JO~^fL~
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? 'l4Q. <;:.
(cubic yards)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
we::
Ilr--l IV n-r /.l t..rf J r I f::J A.-n::::
A>-.l'1 "'.J V IRn"-l I-A':=- r-JTAl..
I H ?AC..-
nL.J .,...1-fC' vv;;--r, A...,OS A......J.O --rJD..o...L
1A/~"1"'j::"I<."'"
Olle:-
-r,!)
C'll....I5-.-r-{?dC~/r-'\^/ '--:::."F
A SIt\./(5.l G. ....p-~L..A'L'"-f ~C~JI1t:=-A.f~t==
l)tJ J'""'1..4- I ~
""".-,E.
4Itoard of Trustees APplicatJlt
County of Suffolk
State of New York
-:;:,TC ,1tC-.J c:...a.-r.c...L.D.o BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRlBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
,
TRUE TO THE BEST OF HISIHER 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
REPRESENT A TIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH VIEW OF THIS APPLICATION.
2
SWORN TO BEFORE ME THIS '-- 1 "" DAY OF ful6~""\ ,202!:[
::;;:: __W~
Notary Public
JAMES W. GLANDER
Notary Public. State of New VOlle
No. 01 GL60277B3
Qualified In Suffolk County_~
Commission Expiras Jul~ 12.~
Board of T:cus.tees App.Llca.tlon
. .
...
AUTHORIZATION
(where the applicant is not the owner)
IJ .\/~ K. DL\. Sll_"..j~'
(print owner of property)
residing at S C.AI~. vv/' ,-.,.. TlSk."'-..4<"E.
(mailing address)
s}--t J .-r""I_I...-r-....-..lNI...L
\,..1. 'I.
o
I n ?-JI
do hereby authorize
(Agent)
"'-,-n;".V1?,,1 (...-'-rAL.O,-, AI "",. to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
~~/.J;a of~
{/ (Owner's signature)
8
1,~.:5.J. (2/87)- Ti~xt 1'2
SEQ
'.
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)
PROJECT 1.0. Nu.'AaE~
=
I 2
PROJ EC7 ;\lAM E
1. APPLICANT 'SPONSOR
OS, c::
J. PROJ ECI LOCATION:
,I,1uniclpality -::, .:.;. D . County S U"'::--':;~Lj,c
.1. PAEC:SE LOCATION (Street address ana'road intersections, prOminenllanamarKs. etc., or .JrOVloe map)
L.
"
TAR-PO..... De,vG', ;:,O.....THOL..O. "-,,,.
"22. s,' €.. AS"'- 0'1'"" ~ "-, ~ RoD (S. 0:;; ... OS)
<;'OU.,-I.. SIO.. or- --rA~f'o"-l P~I vr;;;:
'-
5. IS PROPOSED ACTION:
New 0 Expansion
o Moaifica(ionialteration
5. DESCRIBE PROJECT 5RIE:=LY:
.3Sc:::o S Q For
S Jv(QL~
-~A~i'r....."'l
""'" .s1~A.f~
7. AMOUNT OF L.;ND AFr=;:CTE:J:
Initially . 4- " acres Ultimately , A~ acres
3. V,'IL!... ?RO?IJSE0 ACTION CQMPLY WITH E.,'<ISTING ZONING OR OTHE~ EXISTING L.Ai'W USE :1.c::SI rllC7:0NS?
JRf Yes 0 No If No. ~escnbe brleily
9. 'f/HAT IS PRESENT L..;t~O USe IN VICINITY OF PROJECT?
'0t ;;\2s1denlial D.!nauslrial 0 C0mmercial
Desc;lbe:
U Agriculture
~ ParKlForestJOoen soace
OOtner
10. DOES ACTION INVOLVE A PEr:1MIT APPROVAL. OR FUNDING, .\lOW OR ULTIMATELY ~rtOt.1 ANY OTHER GOVE?NMENIAL AGENCY {F=:DERAL,
STATE On LOCALl?
Ell Yes 0 No If yes, lisl agency(sl and permil/approvals
TOWN 01'" .sO...,.,-;..lOL.D BU\L..D'.JG, p,e.p-r;
..::r-
11. DOES ANY ASPSCT OF THE ACTlor~ HAVE A CURRENTLY VALID PERMIT OR .=;PPROVAL?
~ Yes' 0 No II yes, list agency name and permit/approval
P~c..
j.I,E-....l.--r1.+ D", p-r;
12. AS A RESULT OF PROPOSED ;.,CTION WILL :=/:/STlNG PERMIT/APPROVAL ilEOUIRE .\10QIFICAdON?
DYes . ~NO .m
I CEiiTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE 70 THE 3EST OF MY KNOWL=DGE
Applicant/sponsor name:
~ VEt-.t c..d.-r-ALr:ln
.4.J.o....
Oute:
Signa lure:
If the action is in (he CO<Jstal Area, and you are a state agency, complete the
Coastal ASSEssment Form beiore proceeding with this a.~~essment
OV!:R
~~~
.:... :OE.S ..;C:-;C.'l ::.\L..::=.:.... ,:.,'lY ;
'__S3\\1ENi ,--:-0 O~ ,::8r:-,:i2~2C :'1
,.~;=:ESr.GU !N? .'l':'C?,::::, .:1:"'=.1 ~:7.~Z.?
,~'.;e!:c
?0..riT 11_~:'l\jIRC~I;\~E:-~I~'
,/ ,e.s.
.:.aIS :,'la feVltl'.^l ::ccese
ana 'JS<:i :r.e .='JL:... ::"AF.
_. 'NIL:'" ..;C;-:C.... .,:;::.::=.:v::: '::OPOI",:..7;::0 _=iE.~fIEW...:..5 .::~.C'/IGEJ .=.:;:; UNLS;-:::J ..:..:::-:-,0.'15:;"15 :.n-::=:R. ~i;j::;";- :,,7.::-
.TlJ.'/ ::Ie su:::e,sacec ~y :;.nCl"er ;nYOlvea <1I~enc'-'.
;-...: ':'~s
1_ ~..o
:1 .'':0. =. ."le::;:H!'/8 -:ec;ar~
L; ':'es
'-.: .'10
c. C::'ULO ..:..C7.:CN _~E5UL:- :,'/ ANY ;..OVE;::.Si::: ~.=:=:::.:::"7S ASSGC:,;,:::J ',l/Ii:-! ':":-:= ;.]lL'':;WING: ;;'ns'",ers :-:-:';"/ :e ,1a.nc~yrll~en. ,/ :e:;;IOI2)
(:1. ::.~isring ::iir (:uaJirj. 3urfac~ "Jr- grOl.:na'.vater cualil'i .;:r ::wan(lly, .1015e ;e'/eI5. -:x:s.tnq ::al!IC ::aHe:r.s. selia ....asie :UCCl.:c:::::;n Jr :lIs::::
;l0:erHl31 (er =rO$;on. :':,3.1n2<;e or :Iaocinq :;IrODlems? ~-,,:oI31n ::Jrieily:
1~.Jc?
C2. Aastoelic, :1l;r:c:":!lur31. HC:12iOOIOgIC.:lI, .1ISionc. :ir Oll1er :1::.twrat "Jr c:.JIlUro.1 :eSOt;rces:or communlly or i'lell;;:ccrnccc c~2rac::er? Stolaln ~.
N.O
.......... Vet:;elallon or :aun3. :isn. ~~elliisn or wilollle soec:es, ~Igntiicanr .'1aOilals. or :ore3te('leC or ~ncanc,;ereo ~c:ec:es? Scl.aln ::Jriarly:
NO
c~. A c;::mmunll'f'S exis;:ng ;lL2ns cr goals as oiiic:Slly aQOOlea. ar a crlange in usa or intensity or use 01 lane or ccoer natural resourcss? ~;tplaln :::
NO
C.:. GiOWCO, s.uDseCUe:lc :e\le(ooment, :}r relatea ac::viiies likelY (0 oe Inducea by loe -;:recoseo ac:icn? =xOlaln ::JneiJy.
NO
l.::J. I_cng :erm, :sner: :arm. ''::.Jmuialive. or '::lll1er ~riec:s ncc icerlliiiea ;0 C~.C5? ::.~::'llaln ;Jrleil'!.
l-..J CJ
C:t;:er :moac:s dnc:.;c:ns ~:-.an~es In 'Jse oi ,::lner ::g.!anUly or :'fj:::e or =!1erg:o? =,,:CJI::'II, ~r:ell'l.
NO
':
'_"!es
. '?:c. --
:~ '. .::......c::.
,_,'lo
:_::,,':::~':' 7C 3E. ':::::o'IT.=iOVE?,S'f ;:'E~IE:J 70 ?OTE:'ITI";L ;..81/=.:::52 :;,;'IV\RCNME:-fi;'L :!,~P':"C:-S?
'J. :5 ;-;-;E:::.E. '",n
~f ':'es. ,:;(clam~riell,!
PART 111_OETE::lMINATION O~SjGNIF1CANC;: ~To 'Je completed jy Agency)
iNSTRUCTIONS; ror e3C:1 adverse edec:: idemiiieCl 2.cove. determine whether it is substantial, Jarge, imcof'(i:.O( or omerNise signitic.
=2C:l eifec: SilouJd be assessed in c:Jnnecricn wiln its (a) setting (i.~. uroan or rural); (bl,;Jrobaoility 01 oC:::Of"ing; (C) duration:
irre'Jerslbilily; ;el geograonic .3c::.oe; ana (f) magnltuae. II necessary, aad attachments or reference supponing materials. =:lsure
eXPlanations c:::nfaln SUfficient celaii !O snow lhat ail ~e!e'lant adverse impacts have oeen idemifiea ana adec:uatsiy aCcressec:;.
...:
C:'ecx ,his ::)cx ;f ~Jou have idemifieci one or more .:Jotemially larr;e or significant 2.G'/erS2 imoac:s whic:! ,"1 A '(
oc::,J(. 'Then :Jrcc2~a Girec:1y to. ,ne FiJLL ::AF :::.na/or ;::repare a positive. declar3ticn.
C:'ec:-'\ :his 8QX d 'Iou have de~e(mjned, based on the information and analysis above and any supoortin~
coc'.Jmentancn. :n2t ;he arooosea <ic;ion l,VILL ,'~OT result in...3.-ny signific3nt adverse envircnmem2.t imcac::::;
AND ~rovice en 3,;:tac:1men(s 3.$ necessary, (he ,easons supporting (his dererminotion:
"..,,'~ nr _<:..I'l "~'iCnCI
.-'"nl Jl : v \':1:: '<.,In~ JI ,,',ccn\.OII:: '''';ll,(~r .n '_,".JQ ~,'~<:l'('J
: 'lll:: ';;11 ,{<:",oon~IOI<: UII,(cf
},'((l.iIW(c.n "''-,:,:.J..H~( (Ir ":11:';"l::nl :r~m '-l::jOon~IOI~ :.Jrl'(~'1
~,<:nJIl;r~ '~J -\<;'lcon\iOl<;' '':11,,,:,,,, .., ~"..Iu .~~"nc'i
..J.J:C
2
Name and Address of Sender Check type of mail or service: Affix Stamp Here
0 (If issued as a
Certified 0 Recorded Delivery (International) certificate of mailing,
0 COD 0 Registered or for additional
0 Delivery Confirmation 0 Return Receipt for Merchandise copies of this bill)
0 Express Mail 0 Signature Confirmation Postmark and
0 Insured Date of ReceiQt
linel Article Number Addressee Name, Street, and PO Address Postage I Fee Handling Actual Value Insured Due Sender DC SC SH AD AA
Charge if Registered Value if COD Fee Fee Fee Fee Fee
R:o'OC1~_;r 'it €-/~AJ 5c::..~/:a..~
1 7 7 C22.3!1/.4"~ 0....."- IV.E.C-<- /2...0 I
~2CC>3__UO_QQ:JS_.s! , 1--'" ;c:s.=-l'S'-.-P-f'./~-r~/-'-7-<J,S
2 1<-..C-.w.-t2D ~ j'rOAJ.A:l.. J-If~ I
7< 31 0;)5750'- "i923 '0 'M1c....r"",,- AA"':ti J 7
Cl23_ Jt:J_Q_ . , ,_ _~4,~_Ga.=,""",-- _ _._~._ L ,SiS
H-.o..~o'-O .e- pa.,l-; p~ ~
3 4QS4- 'OSS SVN"'-.&"" wt.
_~JJO_t2:X2S 750L l--r_"'-d3re.=I<.--A.L.-y-----LIS.b3
Pi2l..'- P"" vEL-<=> FME>VT '-,~<-
~ 7QQ33_LI.O-CCOS 7507... 4 ~.kJ~~.:o~~~~~~I<L't_.-I-l~-'f-7
5
6 ~-:-~ 'C?
~,::,
7 ~I .~
8 :s ,~) ~ ,i~
~~ '3:
\~j f9 "
c:::~ G
9 li.-j (~-; ,;-D c''''
!S ~~ "','
r:~ r:1 ,~
@J ~:o; ~_f; "r; 0;
10 ,'C:.1 CO C!:
(::1 'l'::::.l (:'I:
%~ t.:o.J ~
-[i, ,~ t:'J
11 is @) @ [s
. C':)
,= :"~
rs 0 [,3,
12 @ ['" CJif
"-"- c"J
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"
13 ~~~} \3
~;. t-[,~~
;1
14 ~ ,,,
r5D
(I)
15 @ =" IS
-
Tolal Number of Pieces Total Number of Pieces Postmaster, Per (ra~f receiVin~~f!j) The full declaration of value is required on a I domestic and international registered mail. The maximum indemnity payable for the
Listed by Sender Received at Post Ollice ~ t reconstruction of nonnegotiable documents under Express Mail documenl reconst (uctien insurance is $500 per piece subject to
Lf additional limitations fOf multiple pieces 105\ or damages In a single catastrophic occurrence. The maximum indemnity payable
~ 'II;\, , ;I on Express Mail merchandise insurance is $500, but optional Express Mail Service merchandise insurance is available ror up to
~ ::z: $5,000 to some, but !'lOt all countries. The maximum indemnity payable is $25,000 for registered mail. See Domestic Mail
\ \ ~ A ~ Manual A900, S913, and 5921 for limitations or coverage on insured and COD mail. See International Mail Manualfor limitations
~ of '''''''' 00 IcI,m,lIoo" m"l. 5p"'" Modli', oh",,, '00" 00', 10 5food'" ",iI IA) ,,' 5fo"'" ",iI IB} p""'"
PS Form 3877, August 2000 Complete bl-T.y . r, Ink, or Ball Point Pen
"'< 1 ^
ell.
.
~l \
.,..
.
,
PROOF OF MAILING OF NOTlC
ATTACH CERTIFIED MAIL RECE
.,
'I
I
I
MAY 2 6' 2OO'f
'.:
Name:
Address:
s
I'
. i
1
.,
,
DeL..'- O....VE....OP""""
e.. N-r- L L- C-
p.O. -a..D,,", Goo
WAD;"" ~ ",V.lE-Yo<... ,^i y. '1/"7'2-
R05.e:......... E! .
<=:., LE.€.N '5c.l-j 1-<\""'.........
c; ,"5 0_":' I'JEc...k:.. 0<:.-0
I
W""'-""........ 'SLIP, N-7'. II' ",.S
R, C-\.-!. ~R...D ~ ,V\~ N "'- Hi c..K.
fb IN' "'- C. r-Je......... ~ ....s E...
l....-4~ G;; r>-ov.e.. N. "1. I' ,C;; S
\-1.0..1'2..0'-0 ...
c: c;. -'47
12'~"""-e.
BSS 'SUVr<...l~E: HVV,.
Ly rJ~<'1:..=o""-. r-J-7' 'ISc:;,.3
STATE OF NEW YORK
COUNTY OF SUFFOLK
STC-V?rJ C.4-rA..L ~ , residing at 14 "-A 12, r..v"" So';'... ,-r'Lr'T"C! WN N-~. '172>'
~ . I I
, being duly sworn, deposes and says that on the
~~ day of MA.Y , 20~ deponent mailed a true copy ofthe Notice
set forth. in the Board of Trustees Application, directed to each of the above named
persons at the addresses set opposite there respective names; that the addresses set
opposite the names of said persons are the address of said persons as shown on the current
assessment roll of the Town (}f Southold; that said Notices were mailed at the United States Post
Office at 5-", ....-L-.--rOVv' '" , that said Notices were mailed to each of said persons by
(certified) (registered) mail.
Ivre~ {i!/A7
Sworn to before me this 'i ++1
Day of tll'\-( ,20~
~
..- l Notary Public
JAMES W. GLANDER
Notary Public. State of New YoIIl
No. 01GL6027783
Qualified In Suffolk Coun~. --.'T
Commission Explree July 12, "''''.1
.
1>.1'PLtCI>.N'f .
TllllNSI>.CTIONlIL DISCLOSU POIlH
The Town o! Soulhold's code of E~hica .iohibi~s conflicts ot
"tarsal on the parb Of tONn off cers and employees. Ttle
purpose of 1:.]11s forln is to provide information which can
alert the town of possible conflicts of interest and allow
it to ta,ka ~hatever action is 11eCeSSary to avoid same.
YOUIl NMB t
"".
C 0 '--V':.o'1-..
Last name, first namsl m dd.le
you are applying in the name oE someone else DC
qther entity, Buell pB a cOlopany. If 80, indicate
the other person's or company's name.)
! ,~,;:\:~ti-'.Hi?f~~:~.~.\'
N^TURB OF APPLJC^TJON, (check all tha~ applY.)
- .<:~ ':;~~trf.', :::-.-:t:',.:.;..~fj ~.:~~~t~
Tax grievance
Varie,nce
Change of zone
I>.pp';l"'al of plat ~ ,I,
Exemption from plat or official map
Other .
(If lIother/u nantel:.he activity.) ~lHL.oJ"';G.. ~..e...t--CI-r-
Do you peruona11y.(or through roue colitpany, spuune, sibling,
parent, 0(' child) hove a relntionship with any officer or
employee of the 'i'own of Southold? "Helntionship" incluues
by blood, marriage, or buslness Interes~a "DualnesB
interes::''' Jl"\eana, n buslneFJB, including a part::.nership, in
which the town officer or employee has even a partial
ownership of (or emp~oyment by) a corp.oration in vhich
th.e tovn of ricer or employee owns mOl:"e than 5% of t.he
eharea. /.
YBS NO
If you anavt!ced IltEs,M. complete the balance of this"form nnd
date anu algn uhere indicated.
Name of person employed by the Town of Southold
Title or position of that person
Describe the relationship between yourself (the applicant)
and the town officer 0(' employee. Either check the
appropriat.e line ~J through DJ and/or. describe in the space
provlded.
The town officer or employee 6r his or her spouse( eibling,
parent., or child is (check all t.hat apply) I
_____^) the owner of greater than 5% of the ahares of the
corporate sbock of the applic~nh (when the applicant'
'ls a corporation),
_8) che legal o'r beneficial owner of at1y interest:. in 8
noncorporate'entlty (when tIle applicant iB not a
corporation) I
_C) an officerl director, pa.rtl:tetl or emplbyee. of the
applicant, or
~D) the a~tual applicant.
..,.'
. ..,'.:
'.'~'.:'-~ .
DEscnIPTloN 0[' RELI>.TIONSIIIP
f..l.
I .
.....-,...
...".:,.,..,.:"'".:"
- ' . ".:~~,
....,.,-. .,.
S\.1b\t\1tl;.ad
t h I ~":,..:;;,,~;;i~~~!%~~/ ;t~~'%(1~V
signa bure
.prlnt hame
.- :.-~.
,::'.'.,,,
,-"..;".'
..,-,.-.'
-...... .-"'.. ".
" :"",j ;~;~';~i;,~\[~~;;,;::;\t:,1;1~l~;~" , '
;").\"c.""t""'(.~I+;,ra';~dJ~~"iB'~''"!t,'f;.~,!!;t""
.;,-".,_,:-., -. '.:.: lJr..:i~';~ .-,:'~~~~:..r:;,) ,',\..':~~:'.~: :'
:G_~}'.
STEVEN CA TALtt A.I.A.
ARCHITECT
14 Karl Avenue
Smithtown, New York 11787
-.
LETTER OF TRANSMITTAL
TO
SCARCH@OPTONLlNE.NET DATE 3/1/04 IJOBNO. 99100
(631)724-2141 F, (631)724-0407 ATTENTION: Lauren
RE: ProDOSed residence for Jack DISilva
TarDon Dr. Southold
, BOARD OF TOWN TRUSTEES-TOWN OF SOUTHOLD SCTM 1000-57-1-4
53095 Route 25
Southold, NY 11971
Q~~~ij~~fIT\
WE ARE SENDING YOU o Attached o Under separate cover via ~ "'" - e 'iiI!\d! fTlS:
o Shop drawings o Prints o Plans Samples Os 'ficati s
o Copy of letter o Change order 0 Monev <outhold Town
Board 0 lruslee
COPIES DATE NO. DESCRIPTION
3 1/27/2004 AODllcatlons
3 Site Dlans
1 check no. 812 for $250.00
THESE ARE TRANSMITTED as checked below:
o For approvai
o For your use
o As requested
o For review and comment
o FOR BIDS DUE ON
o Approved as submitted
o Approved as noted
o Returned for COrrections
o
o Resubmit
o Submit
o Return
copies for distribution
coples for approval
corrected prints
o PRINTS RETURNED AFTER lOAN TO US
REMARKS:
COPY TO: file
SIGNED: c1.A.. ~_. '
.-.....
~'
",
"'-,,-
'.