The URL can be used to link to this page

Home My WebLink AboutTR-4387Board Of $outhold Town Trustees SOUTHOLD, NEW YORK PERMIT NO 4~.? ............. ISSUED TO .....E.d~ir~_.!~rat~ardt ...................... Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Town Ordinance en, titled "REC=ULATINCo AND THE PLACINC= OF OBSTRUCTIONS IN AND .ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND,' C=RAVEL OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;" and in accordance with the Resolution of The Board adopted at a meeting held on 19........9.~ and in consideration of the sum of $......~ ............ paid by Edwin Bernhardt of ...~?.!.~. ............................................................ N. Y. and subject to the Terms and Conditions listed on the reverse side hereo~, of Southold Town Trustees authorizes, and permits the following: Replace existing bulkhead within 18", with the condition thai there be a 10' non-turf buffer between the bulkhead and the house. Located 500 Koke Drive, Southold. SCTM ~87-5-4 all in accordance with the detailed specificat'ions as presented in the originating application. IN WITNESS WHEREOF, The said Board of Trustees here- causes its Corporate Seal to be affixed, and these presents fo subscribed by a majority of the said Board as of this dat, e. Trustees Albert J. Kmpski, President John Holzapfel, Vice President William G. Albertson -- Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box l 179 Southotd, New York 11971 Telephone (516) 765-1892 Fax (516) 765-18-23 Office Use Coastal Erosion Permit Ap~ ~etland Permit Application __Grandfather Permit Application Trustee Lands Permit Application Waiver ~eceived Application: ~erical Review: [~umpleted Application [~.~ncomplete %.---- SEQRA ~lassification: ~YDe I V~ Type II Unlisted ~__~oordinati~n: (dat--~ent) ~./~..~7~---.~ ~AC Referral Sent: ~ /'~ i/ Date of InSpection: /_~_~Recelpt of CAC Report-. . (date) /_~__~ead Agency Determlnatlon:r3~¢. g,.~.. · /Technical Review: (date) ~£$. %~ ; /~/~¢ ~Public Hearing: (date~'//i/~ ' /,' ' Decision: Approved Y~/~)/(date) ,,/[?/~ Application Fee ~ $ /~-~.~{) ' ~ddress DOC3 Suffolk County Tax Map N~ber: 1000 -~~--~--~ Property Location:. 50 O (provide LILCO Pole' 9, distance to cross streets, a~d location) Agent: (If applicable) Address: Phone: 1 ard of Trustees Applicati( GENERAL DATA Land Area [in ~: Area Zoning: ~ ~_~ ~1 Previous use of property: $~'~..,~2~5-i~D Intended use of property: Prior permits/approvals for site improvements: Agency Date __No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? i/No Yes If yes, provide explanation: Project Description (use attachments if necessary) ~.l'ard of Trustees Applicati~ ..... WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:~c~ Area of wetlands on lot: ~quare feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve~xcav&ticn or filling? No / Yes If yes, how much material will be excavated?~cubic yards ~How much material will be filled? cubic yards Depth of which material will be.rcmcvc~ or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be~emove~ or deposited.'~k3~ Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate): 6 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES PERYVtlT k'O 27B Pursuant to the provisions of Chapter 615 of the Laws of 1893 of the State of New York and Chapter. 404 of the Laws of ] 952 of fhe State of New York and Jn accordance with the resolution of, the Board of Trustees of the Town of Southold adopted at a meeting of said Board or~ ....... ~.13~[~.~1.,...~.~ ....................... ~ and in consideration of the sum of $...tiD.,O.~j,, lawful money of the United Stat~s ........paid b~' ]T:..~ ..-~..~J~j~'-' -' ,' · .............. iJ&u,; & residing at ........ ~-.V~qlf.~..,~O~h~13~..L~Z~, ............. ~ ......................... , New York, the said Board of Trustees of the Town of Southold, Suffolk County, Nev~ york, hereby authorizes and permits The said ~I~..K~L.~.,...~- ,...~L,..j&~j~.;~,~t~t~li~i~he consideration for the issuance of this permit does hereby release the said Board of Trustees and the Town of Southold from any and all damages, Claims for damages or suits that may arise or occur directly or indirectly as a result of any operation carried on under and pursuant to this permit, and will at hi.~ own expense, defend any and all suits which, may be brought by third parties as o result of any operation carried on pursuant to or in accordance with the terms of this permit, and assume full liability with respect thereto to the complete exclusion of said Board of Trustees and the Town of Southold. ' ~ 14-16.4 (2/8TI--Text 12 · · ' I PR~)JECT LD. NUMBER .J 617.21 Appendix C State Environmen~tal Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only SEQ PART I--PROJECT INFORMATION (To be comp eted by Applicant or Project spbnsor) I1. APPLICANT/SPONSOR ~ [ ~ ...~2. PROJECT NAME' 3. PROJECT LOCATION; ~' tt . ~. ~ {)il t i 4 PRECISE LOCATION (Street addreSS and road intersections, prominent landr~arks, etc., o~ provide map) 5.'. IS PROPOSED ACTION: ~] New [] Expansion 6, DESCRIBE PROJECT BRIEFLY: [] Modificat ionlatt eration AMOUNT OF L~ND AFfliCTED: Initially ~) ~ acres Ultimately WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ,~es No, describe briefly []~o If g. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? ~Residential [] !ndustria, I [] Commercial [] Agriculture [] Park/Forest/Open space Describe: % ~.~ ~.) ,,,~ ~::~ ~ _.~. ,~. ~.~[ [_~_.. ~ ~:~,.~ ,~ ~.~ ~__ ,~..~ [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? .~.Yes No If yes, llst agency(s)'and permitlapprovals 11, DOES ANY ASPECT OF THE ACTIOH HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes ,J~No If yes, list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? [] Yes ~O I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a__~s, essment OVER 1 PART II--ENVIRONMENTAL ~ESSMENT{,, ,L (To be completed by Agency)~,,, . . , A. DOES ACTION EXCEED ANY TY~,I.ff~THRESHOLD IN 6 NYCRR, PART 617.127 tf yes, ~6JoJ)rdinate the review process aha use'the FULL~ E'SAF. '" [] Yes [] NO ,~ B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.67 If No, a negative declaration may be superseded by another involved agency. [] Yes [] No C. COULD ACTION RESULT IIq ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) Cl. Existing air qualityl~ surface 0r'groundwater qual ty or quantity, noise levels, exist ng traffic patterns, sold waste production or disposal, potential for erosion drainage ~or f ooding problems? Expl~tin briefly: ~ ~ C2. Aesthetic, agricultural, archaeological, historic, or ~ther natural or cultural resources; or community or ne(ghborhood character?. Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as officially adopted or a ~hange in use or intensity of use o! land or other natural resources? Explain briefly C5; Growth, subsequent development, or related acti'~ities kely to be induced by the proposed action? Explain briefly. C6. Long term, short term, cumulative, or other effects not identified in Cl-C57 Explain briefly. C7. Other impacts (inclUding changes in use of either quantity or type of energy)? Explain briefly. D. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO' PQTEN~TIAL ADVERSE ENVIRONMENTAL IMPACTS? [] Yes [] No If Yes, explain briefly PART IIImDETERMINATION 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 rura0; (b) probability of occt]~Jag; (c) duration; (d~ irreversibility; Ie) geographic scope; and (f) magnitude. If necessary, add attachments or reference support ng r~aterials. Ensure that explanations contain sufficient detail to show that alt relevant adverse impacts have been identified and adequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positJve'declarat on. [] Check this box if you have determined, based on the nformation and analys s ~bove and' any supportin documentation, that the proposed action WILL NO~" .... ,. ~ ~.; ~ni~i~, .... -- ' g . .~u~t .,_~.y o,~ ~ ,~,~,~ ,~uwrse environmental impacts AND provide on attachments as necessary, the reasons supporting this determina!~on: Signature or Preparer:(If different tt~m ~espon~ble otimerl ard of Trustees Applicati% ~ County of Suffolk State of New York BEING DULY SWORN DEPOSES ANDAFFIRMS THAT HE/SHEIS THE APPLICANT. FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THEBEST OF HIS/HERE/~OWLEDGE AND BELIEF, AND THATALL WORK WILL BE DONE IN THE MANlqER SET FORTHIN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. HE APPLICANT AGREES TO HOLD THE TOWNOF SOUTHOLD~AND THE TOWN USTEES 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, EIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY OINSPECT THE PREMISES INCONJUNCTION WITH REVIEW OF THiS APPLiCATiON. S~ature swo TO BEFORE ME THIS otary Public JOYCE M. WILKINS Notary Pub;;c, State of New YoH; No. 4952246, Suffolk Counl~ Term Expires dune12, 19 ~'~- Albert J. Krupski, President John Holzapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - TOwn Hail 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 November 18, 1994 Mr. Edwin Bernhardt 500 Koke Drive Southold, NY 11971 Re: SCTM #87-5-4 Dear Mr. Bernhardt, The following action was taken by the Board of Town Trustees during its regular meeting held on November 17, 1994 regarding the above matter: WHEREAS, EDWIN BERNHARDT applied to the Southotd Town Trustees for a permit under'the provisions of the Wetland Ordinance of the Town of Southold, application dated September 15, 1994, 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 November 17, 1994 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 Board has detezmined 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 approves the application of EDWIN BERNHARDT to replace existing bulkhead within 18", with the condition that there be a 10' non-turf buffer between the bulkhead and thehouse. Located 500 Koke Drive, Southold. SCTM ~87-5-4 Permit to construct project will expire two years from the date it is signed~. Fees must be paidr if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trusteesare to be notified uponcompletion of said project. FEES: None Very truly yours, Albert J. Krupski, Jr. President, Board. of Trustees aJK/dj h cc. CAC 0 Albert J. Krupski, President John Holzapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 S.E.Q.R.A. NEGATIVE DECLARATION NOTICE OF NO SIGNIFICANT EFFECT ON THE ENVIRONMENT APPLICATION NO. 1000-87-5-4 NAME:EDWIN BERNHARDT DATE: October 27, 1994 Chapt. 97 Wetlands Chapt. 37 Coastal Erosion RESOLVED that pursuant to Article 8 of the Environmental Conservation Law, State Environmental Quality Review and 6NYCRR Part 617, Section 617.10 and Chapter 44 of the Code of the Town of Southold, notice is hereby given that the Southold Town Trustees, as Lead Agency for the action described below, has determined that the project will not have a significant effect on the environment. Please take further notice that this declaration should not be considered a determination made for any other department or agency which may also have an application pending for the same or similar project. TYPE OF ACTION: Type: I DESCRIPTION OF ACTION: Applicant requests permit to replace existing bulkhead within 18" with the condition that there be a 10' non-turf buffer between the bulkhead and the house. Located 500 Koke Drive, Southold. LOCATION: SCTM 91000-87-5-4 REASONS SUPPORTING THIS DETERMINATION: 1. An on site inspection has been conducted by the Board of Trustees. 2. An environmental assessment, submitted by the applicant and reviewed and completed by the Board of Trustees, has indicated that no significant adverse effects to the environment are likely to occur should the following mitigation measures be implemented. cc. CAC Telephone (516) 765-1801 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL Town Hall, 53095 'Mai~ Road P.O. Box 1179 Southold. New York 11971 TO: Southold Town Board of Trustees FROM: Southold Town Conservation Advisory Council DATED: October 20, 1994 RE: Recommendation of Applications A meeting of the Southold Town Conservation Advisory Council was held Thursday, October 20, 1994. Present were CAC members Stephen Angell, Jack' Hagerty, Patricia Isaksen, Allan Connell, and Betty Wells. The following recommendations were passed: RECOMMENDATION OF WETLAND APPLICATIONS No. 1193 Moved by Patricia Isaksen, seconded by Stephen Angell, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL of the Wetland Application of JEANNE WHATMOUGH 122-3-38 to reconstruct a new entryway and porch; enlarging both and providing a roof over both structures. Entry way 6 x 13; porch 15 x 22. 180 North Riley Avenue, Mattituck Vote of Council: Ayes: All Motion carried. No. 1194 Moved by Allan Connell, seconded by Jack Hagerty, it was ~ . RESOLVED to recommend to the Southold Town Board of WITH PRO¥11SiONS of the Wetland Application of to replace 83 feet of existing bulkhead within 18". The CAC recommends approval provided the applicant uses caution and does not destroy spartina in front of the existing bulkhead and that a buffer of spartina patens is planted in accordance with the Town Code. 500 Koke Drive, Southold Vote of Council: Ayes: Alt Motion carried. Meeting of ~, October 20, 1994 No. 1195 Moved by Stephen Angell, seconded by Patricla Isaksen, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH STIPULATIONS the Wetland Application of PATRICK COLAC~UIuRI 123-3-22, 2:3, 2~ to replace within 18", 128 +/- I.f. of existing timber bulkhead. Easterly 16' return will be removed and replaced and extended by 14' to 30' inside of existing concrete return. Westerly 11' return will be removed, replaced and extended by 25' to 36' overall. Approximately 65 c.y. of clean fill ~iiii be trUCked in from upland source for backfl I. The CAC recommends approval with the stipulation that the north side is replaced '~in ki'nd and in place"; the boardwalk not exceed the current dime~si0ns not~ extend to 5'); and plant all exposed and backfil'led areas 2950 Council: Motion carried. s: All No. 1196 Moved by Stephen Angell, seconded by Allan Connell, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WIT~I STIPULATIONS of the Wetland Application of MICHAEL LEAHY to construct an addrtion of 20' x 24.8'; 2 story addition to existing 2 1/2 story house; addition of rear dormer at upper floors of existing house; addition of 15' x 42.7' deck at back of house; construction of dock. The Council recommends approval with the following conditions: 1. Dock - The Cou~r~cil approves the original configuration on the plan submitted 9/15/94 as it is a more appropriate configuration for the dock. The CAC cannot support a 110' walkway. 2. Wood Deck - The CAC recommends approval 3. Conservatory or greenhouse - The CAC recommends approval L~. Covered porch - The CAC recommends approval 5. Second ~tory office - The CAC recommends approval however, if a bathroom is added, the CAC would need know the location of the cesspool system before recommending approval~ 6. Second story addition to house - If bathrooms are added and a new cesspool system is needed, the applicant would have to locate the system and obtain a recommendation of approval from the CAC. The CAC recommends approval if there is no change to the system. 2200 HObart Road, Southold .Vote of Court~il: Ayes: All Motion carried. No. 1197 Moved by Jack Hagerty; seconded by Patricia Isaksen, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL OF PART of the Wetland Application of PREM C. CHATPAR 90-2-9.1 to reconstruct 116~ of bulkhead within 18" of the existing bulkhead plus return on south side; construct 85' retaining wall 245" above grade; repair 56' of bulkhead; construct 30' x 4' fixed dock; use approximately 100 c.y. of fill from an upland source. The CAC recommends approval of the 116' and 60' bulkhead. The Council recommends disapproval of the 56~ bulkhead. The 56' bulkhead is not Page 2 GAll S. SHAFFER SEERETARY OF STATE STATE Of NEW YORk DePArTMENT Of STATE AlbaNY. NY 12231-0001 Mr. Albert J. Krupski, Jr., Trustee Board of Town Trustees Town Hall P.O. Box 1179 Southold, New York 11971 September 30. 1994 Re: Lead Agency Coordination Request for Proposal by Edwin & Grace Bernhardt, 500 Koke Drive, Southold, N.Y. Dear Mr. Krupski: With regards to the above mentioned Lead Agency Coordination Request, please note that the New York State Coastal Management Program.does not object to Southold Town Trustees aSsuming :L~d ~Agency. However, the Department of State has yet to receive a Federal Consistency Assessment Form (FCAF) and supporting information for this proposed project. Therefore, please instruct the applicant to submit all required information to Ms. Diana Boos at the Department of State. Upon receipt, we will determined if the submitted information is adequate to begin review of the proposed project for consistency with New York State's Coastal Management Program. If you have any questions, do not hesitate to call me at (518) 474-6000. Sincerely, Walter F. Meyer Coastal Resources Special/st c. U.S. ACOE/NY - Sophie Ettinger file ~ printed on recycled paper Albert J. Krupski, President JOhn~Holzapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (5 I6) 765-1892 Fax (516) 765-1823 LEAD AGENCY COORDINATION REQUEST TO: Whom It May Concern: DATE: Sep~mber 26, 1994 Enclosed is a permit application and a completed part I of the Environmental Assessment Form. Southold Town Trustees are interested in your ageny's comments in acting as SEQRA Lead Agency for: NAME: Edwin & Grace Bernhardt LOCATION: 500 Koke Drive, Southold, NY TAX MAP: ~87-5-4 DE$CRPTN: See Attacked PERMIT REQUIRED: (~ TOWN WETLAND SEQRA CLASSIFICATION: (~) Type I ( ) UNLISTED PEtlMIT 9 Pending OTHER ) Type II ) CEA Please contact ..Albert J. i[ruoski,. Jr., _Trustee -. , within 30 days and be advised that the Southold Town Trustees (WANT)/(DO NOT WANT) to assume lead agency. ~) DEC (~) DOH ( ) PB ( ) ZBA ( ) BAD ( ) SENT TO: DOS ACE ( ) CAC (~) Please complete, detach and return this form to expedite processing. Involved Agency: Project Name: Location: 'SCTM: We at (Have/No) objection to Southold Town AGENCY ~ Trustees assuming Lead Agency. Comments/Reasons: Signature of Authorized Representative Albert J. Krupski, President John Holzapfel, Vice President William G. Albertson --. Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 Office Use One_ Coastal Erosion Permit Applica i~ut~ etland Permit Application Grandfather Pe£mlt ApplIcation jjJjj~ Trustee Lands Permit Applzcatzoni''j Waiver ~/~eceived Application: ~-[~ [TOWN --~lerical Review: ~>ompleted Application j~ncomplete SEQ~lassification: ~ I~~e II UnlistDd ~oordlnation:(date se~t)~/~ ~CAC Referral Sent: ~A~?q Date of Inspection:~~ Receipt of CAC RePorf:(dat~) Lead A~ency Dete~ination: Techniual Review:(date) /Public Hearing:(date) Decision: Approved (Y/N) (date) Application Fee:$ /~.~ ~ ~q'~[ Phone Number: ~[&) Suffolk County Tax Map Number: 1000 -~~7-- Property Location: 50(25 (provide LILCO Pole ~, distance to cross streets, a~d location) Agent: (If applicable) Address: Phone: 1 .... ard of Trustees Applicati~' GENERAL DATA Land Area (in ~ Area zoning: Previous use of property: Intended use of properW.' V~i~m~ ' ~ ~' Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? jNo Yes If yes, provide explanation: Project Description (use attachments if necessary) · ..LJ'ard of Trustees Applicati¼?·~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~c~ ~-~__~-)~l~ Area of wetlands on lot: Percent coverage of lot: square feet % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearesu proposed structure and upland edge of wetlands: feet Does the project involve _. ..--_ ' or filling? No / Yes If yes, how much material will be excavated?~cubic yards ~How much mauerial will be filled? cubic yards Depth of which material will be.rcmcvc~ or deposited: feet Proposed slope throughout the area of operations: which material will be ~ or deposited:~~__ Manner in Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason os such proposed operations (use attachments if appropriate): 6 · ~ ,14-t6-4 (2/873--Text 12 'I"PR~JECT i.D. NUMBER t I 617,21 Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM ~ For UNLISTED ACTIONS Only PART I--PROJECT INFORMATION (To be corn ~31eted by Applicant or Project s~bnsor) 1. APPLICANT/SPON~SO~.R ~ [ ~ J 2. PROJECT NAME 3. PROJECT LOCAT~.~QN: . '/' - ',~ · ~- -- · :{~( ) · ~ I 4. PRECISE LOCATION (Street address ~nd road intersections, prominent landr~arks, etc., o~-~mvide map) SEQ 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification/alteration 6. DESCRIBE PROJECT ={RIEFLY: 7. AMOUNT OF L~ND Initially ~) ~ acres Ultimately 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? If No, describe briefly 9. WHAT IS PRESENT LA~D USE IN VICINITY OF PROJECT? · ~Besidential [] !naustrial [] Commercial [] Agriculture [] ParkJForestlOpen ~space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (FEDERAL, STATE OR LOCAL)? .~Yes [] No If yes, list agency(s) and permit/aporovals ... 11. DOES ANy ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPF~OVAL? ~¥e~ ..J~No If yes. list agency name and permit/approval 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the CoaBtal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this a__~s~essment OVER 1 Albert L Krupski, President John Holzapfel; Vice President William G: Albertson Martin H. Garmll Peter Wenczel Town Hall 53095 Main Road P.O. Box ! 179 Southold, New:York 11971 Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD LEAD AGENCY COORDINATION REQUEST TO: Whom ItMay Concern: DATE: Sep~mber 26, 1994 Enclosed is a permit application and a completed part I of the Environmental Assessment Form. Southotd Town Trustees are interested in your ageny's comments in acting as SEQRA Lead Agency for: NAME: Edwin & Grace Bernhardt LOCATION: 500 Koke Drive, Southold, NY TAX MAP: ~87-5-4 DESCRPTN: See Attac~ed PERMIT REQUIRED: (~ TOWN WETLAND ( ) OTHER SEQRA CLASSIFICATION: (~) Type I ( ) UNLISTED PERMIT $ Pending Type II CEA Please contact .Albert J. Kruoski,..J.r., Trustee . '. .. within 30 days and be advised that t~e Southoid Town Trustees (WANT)/(DO NOT WANT) to assume lead agency. SENT TO: DOS ~) DEC (~) DOH ( ) PB ( ) ZBA ( ) BLD ( ) ACE ( ) CAC (/~.) Please complete, detach and return this form to expedite processing. Involved Agency: Project Name: Location: 'SCTM: We at (Have/No) objection to Southold Town AGENCY ~ Trustees assuming Lead Agency. Comments/Reasons: Signature of Authorized Representative Albert J. Krupski, President John Holzapfel, Vice President William G. Albertson Martin H. Garrell Peter Wenczel BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Main Road P.O. Box 1179 Southold, New York 11971 Telephone (5 t 6) 765-1892 Fax (516) 765;1823 September 16, 1994 Brnce Loucka, Chairman Southold Town Conservation Advisory Council Southold Town Hall Main Road Southold, NY 11971 Dear Mr. Loucka: Transmitted herewith are the following applications for a wetland permits: Jeanne Whatmough 122-3-38 Edwin Bernhardt 87-5-4 Please prepare a written report of findings and recommendations with respect to this application. yours, Albert J. Krupski, Jr. President, Board of Trustees AJK:djh ',( % ~ -' ~ . ' ' . · ".' , " ~ ,[2 ' ~ ' ~ouc^TIo~w. . · : ' / h, ' ' ~ ~ t ~ / CAT~ H~REOa S~ RUa ONLY TO,THE ~ ' / '" * e ~, .~ / PERS~ FOR WHOM THE SURVEY IS PRE- L no/ /o ,~co/~ C~2L--',4/7- ,25' ,4/. SCALE /,,_- ~d2 ' ' .... [] -- MONUMENT - BOWNE & SON CHESTER C. KELSEY SURVEYORS N.Y. [.lC. NO, 36923 FOR