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TR-8607A
John Bredemeyer, President guFF01.to Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King ti $ P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�ol ,� �a°! Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board. of Trustees Field InspectionMlork Session Report Date/Time: EUGENE & MARYANN KRUPSKI Site Inspection for Board of Trustees Condition under Administrative Permit #8607A,to determine if the 10' wide non-turf buffer adequately contains the impacts from the chicken coop with two runs. Located: 2230 Soundview Avenue, Mattituck. SCTM# 1000-100-2-3.2 Type of area to be impacted: Saltwater Wetland v4shwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No /Not Applicable Storm Water Management Review: Yes -No Not Applicable. Info. needed: Modifications: Conditions: n Present Were: J. Bredemeyer M. Domino t.,"ing D. Bergen . Sanders Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: John M. Bredemeyer ill, President g�}Ff©(,i-� Town Hall,53095 Main Rd. Michael J. Domino,Vice-President ��� OGy� P.O.Box 1179 James F.King x Southold,NY 11971 Charles J. Sanders 9 Telehone,631� !� P ( )765-1892 Dave Bergen ��l ' 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, silt fence 1St day of construction '/ constructed Project complete, compliance inspection o' C�-R� ��U�rc�Q John M. Bredemeyer 111, President g1}Ff0(�-c Town Hall,53095 Main Rd. �G P.O.Box 1179 Michael J. Domino,Vice-President James F. King Southold,NY 11971 Charles J.Sanders y� � p!� Telephone(631)765-1892 Dave Bergen Ol �� 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, silt fence 1St day of construction '/ constructed Project complete, compliance inspection .s ,fie yu�fd 0 .-Ovnd PAJ "_ *®F SO(/j�, Town Hall Annex John M. Bredemeyer III, President �V� of Michael J. Domino,Vice-President54375 Main Road P.O. Box 1179 James F. King,Trustee Southold, New York 11971-0959 Dave Bergen, Trustee COQ Charles J. Sanders, Trustee � Telephone (631) 765-1892 ��c'oUFax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 8607A Date of Receipt of Application: April 28, 2015 Applicant: Eugene & Maryann Krupski SCTM#: 100-2-3.2 Project Location: 2230 Soundview Avenue, Mattituck Date of Resolution/Issuance: June 17, 2015 Date of Expiration: June 17, 2017 Reviewed by: Board of Trustees Project Description: For the as-built 11'x16' chicken coop with attached 11'x20' chicken run; and to install 4' high by +/-250' long fencing for a larger chicken run attached to side of coop. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the site plan prepared by Eugene & Maryann Krupski, received on April 28, 2015, and stamped approved on June 22, 2015. Special Conditions: To establish and subsequently maintain a 10' wide non-turf buffer around the existing pond; and for the Trustees to perform an inspection in the fall to determine if buffer adequately contains the impacts from chicken coop with two runs. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. John M. Bredemeyer, III, President Board of Trustees SOUTHOLD TRUS EEs No. S'6d7�9- issued ToEu4�� ��► ���% Date��LZ�l� Address �3o Sou.�dv;e� A,►enue. lI�O,.�►�,,cc�c THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION .TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971 TEL.: 765-1892 I John Bredemeyer, President �ogUFFO(� Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King y P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�OI , , �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field InspectionMork Session Report Date/Time: d A) EUGENE & MARYANN KRUPSKI request an Administrative Permit for the as-built 11'x16' chicken coop with attached 11'x20' chicken run; and install 4' high by +/-250' long fencing for larger chicken run attached to side of coop. Located: 2230 Soundview Avenue, Mattituck. SCTM# 100-2-3.2 Type of area to be impacted: Saltwater Wetland V Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland �zd Part of Town Code proposed work falls under: Chapt.275 eChapt. 111 other Type of Application: Wetland Coastal Erosion Amendment VAdministrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: �v� r, 't � c � � �� � �t/� �/VP Conditions: &0 f- t2- elm 2 Present Were: ✓J. Bredemeyer Vk Domino AT King C. Sanders V'--D. Bergen Bay Constable Other Form filled out in the field by Je Mailed/Faxed to: Date: John Bredemeyer, President �oguFFO(,rTown Hall Annex Michael J. Domino, Vice-President 54375 Route 25 James F. King y = P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen or ,� �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: /�,fl /,' 1 �50 EUGENE & MARYANN KRUPSKI request an Administrative Permit for the as-built 11'x16' chicken coop with attached 11'x20' chicken run; and install 4' high by +/-250' long fencing for larger chicken run attached to side of coop. Located: 2230 Soundview Avenue, Mattituck. SCTM# 100-2-3.2 Type of area to be impacted: Saltwater Wetland U Freshwater Wetland Sound Bay t Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 � Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment t,-Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No ''"Not Applicable Info needed: Modifications: €' �� � �' ' ' � ltA� 6°✓� /'� �4� -, ! Conditions: Present Were: I/ J. Bredemeyer t,.-"M. Domino 61*�J. King C. Sanders AD. Bergen Bay Constable Other Form filled out in the field by �e �` eo (5:-- Mailed/Faxed to: Date: Google Earth streams ` world over wired and wire' s networks enabling users to virtue,,,, go anywhere on the plane. id see places in photographic detail. This is not like any map you have ever seen. 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Put the world in perspective. htt :Hearth. oo le.com Ins .,`. y. y y r 'N` k Imagery 6,'19,12014 • I 69 ft eye alt \ 17 ft APR 1 7 2015 i S 71 APR 1 7 2015 F . .{c a� - W, (A9i 9 Z lCl' SCO.N.S RL 16-00Jr yy g106a07 �.I ,�O RCr�_,JyrBh^'�T 4tr1 �Jl1.01 ye Rr�1Y Ile r gyp; 100, XrY MAP SUBDIVISION OF KRUPSKI FAMILY LC AT MATTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-100-W-03 SCALE 1'=100' ` FESR1/ARY 24.2005 _(y p m�nAsoT,curnw� i Mor ro scuE) I IIPM.LL PLW PEAN rLST NRE a9M % za 9 e LD1 2 / 1 I [E1 AREAS LOT 1-63.551 B¢tL OF 14589 Acrn LOT 2-559985 ACRES TOTAL AFEA-57.4574 AQ.. tMS is)0 aRib"Y THAT,I SHBaVISnN RAI UTH LD BEEN LU,IDN D w BY P,R ANJ.BMRO a LIE TONJ 6 RLnA-B Br rLS0.Urfa' {x� 6 N'PROVAL BRrEa BT_ �_ LTNIPNN fEANMIG 9OwU r APR 1 7 2415 )NETRr pmrm THar rac.vBavrsNN nnr vAs Nan rNm i n rux uavETs ebEae-rEB zAza.>ss r aT.I'd MEs ' :�1 ovN TWs•xruxLr Exar w+B r ror Ale raxecnr IIr1N1�6R� srovN am ALL aNJarbw am rmnr¢META-A.Nc rnrrcr �*zII IS JUL 25 BD) - Ar rxE N.rzx vpa R J Axn/Da xwar wrnasAl srsru(s)rae nas PAorcr1°or d'LA>•BK�"°"` rRe as sicn�En erauE m uNDrR ur owrcnm.a,scu ww A cwcnx Ano nmRa.�ar snor a _ DEP a{A'M of 5£RNffS CWSIRI1L1Xxr Sr.WUARus w ASK 5 OA N:� aX CWNTv - .. nAs SUFFOUE COUNTY DEPARTMENT OF HEALTH SERMCES HAUPPAUGE.N.Y. own ADSERI liBb2rR P.E.UC.ACE OH1510 ---- --- -0 a5'rRlCr.A-C 1145 IS TO CERNT THAT_-.—O REAIJT SUBOMM DN OR lull p51PMr KLOPExxt FCR TIS SbKla pSiRlLr.9 _ A TOTAL OF ORip ON TSE AB OAT.w I S — AND 5[ 0 D9.OSM urRla:S I.—TIE TI WOF CO.—TD CdSTxUC1Rlx ZCT TRDS IN—MATE-PPoVAlE NEU THE IIYE a 1T 11 1ULT(W Nip ME 549JECi TO SEPARATE -WpINWM SFPIM BKRM PERbrS PURSUANT i0 HCSE SiANDAFDS.1HH APPRpVM SMALL BE -rl i.— MID OMT IF P2 REM ry SUBCIHYLN/pE�EL NT MAP IS -LABLE WLT Fur^• N aB:TEAR a nN CON—IS xFRLBTEa EOR T(fB1RO p M ONVERS x T- /AIs DO ENRSEVENT APPEARS W—O010E a THE PM�C'ANiS CWN1T a K W nr xxcwsxr nunLT uurza rrABR rr ca.PAxr FI . amAx¢NTI PNDw OF THE PUBuc Hra IH—AND Tc lass oaEsrw RwD su:rWK calNi. 5—Ml epoe. 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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 �� Telephone: 631 765-1938 COU LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: John Bredemeyer, President 4 MAY 1 8 2015 Town of Southold Board of Trustees From: Mark Terry, Principal Planner LWRP Coordinator Date: May 18, 2015 Re: Local Waterfront Coastal Consistency Review EUGENE & MARYANN KRUPSKI SCTM# 1000-100-2-3.2 EUGENE & MARYANN KRUPSKI request an Administrative Permit for the as-built 11'x16' chicken coop with attached 11'x20' chicken run; and install 4' high by +/-250' long fencing for larger chicken run attached to side of coop. Located: 2230 Soundview Avenue, Mattituck. SCTM# 100-2-3.2 The proposed actions have been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the below Policy Standard and therefore is INCONSISTENT with the LWRP. The pond is not located on the applicants property only. The pond traverses the an adjacent Property owners parcel (see figure 1 below) . 6.3 Protect and restore tidal and freshwater wetlands. The location of a chicken coop and run in close proximity to a freshwater pond could lead to adverse impacts to water quality from fecal matter that could result in high nutrient levels and hypoxic conditions; potentially resulting in die offs of wildlife species (vertebrates, invertebrates within the pond. These conditions could also result in undesirable odors and in extreme situations, human health threats. In addition, site topography indicates that storm water runoff will enter the pond from the chicken run. More information on the farming practices of how the applicants will prevent the chicken fecal matter from entering (washing) into the freshwater pond and handle the disposal of chicken fecal material is needed. Mitigation to avoid this should be proposed. Figure 1. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Lori Hulse, Assistant Town Attorney ®� SOVT Town Hall Annex John M.Bredemeyer III,President �� /y® 54 Main Road Michael J.Domino,Vice-President '`O l® P.O..Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee G Q �O Telephone(631) 765-1892 Charles J.Sanders,Trustee O�g.0®U Fax(631) 765-6641 BOARD OF TOWN TRUSTEESrilp- TOWN OF SOUTHOLD Office Use Only W 23 _Coastal Erosion Permit Application i _Wetland Permit Application Administrative Permit - �- _Amendment/Transfer/Exte SionYJ � r '�,• x `�"' —' Received Application: LIOXIi57 -~- Received Fee:$ IDO® Completed Application _Incomplete _SEQRA Classification: Type I Type II Unlisted _Coordination:(date sent) _CLWRP Consistency Assessment Form _CAC Referral Sent: _Date of Inspection: Receipt of CAC Report. _Lead Agency Determination: _Technical Review: Public Hearing Held: Resolution: "yc'A./1 cell zS/l7 -(,26 7y Name of Applicant r-C,,r r\, /P llLIenQ-1 M xy-,9 qnn f r-yok i, Mailing Address -X-A-60 SaLkra Y 12w 631 Phone Number:( ) ')A -7&U Suffolk County Tax Map Number: 100.0 � 3 Property Location: -1,110 S C _kr_i V( CAA PW9_1r1 W L (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: -)_9 7 Lo�� rd of Trustees Applicatic GENERAL DATA Land Area(in square feet): f v D 0 Sc, Area Zoning: phhll+C-%.k Vu're Previous use of property: Nic)V u�-e_A Intended use of property: fe.Kyn%v r, Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? ✓ Yes No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes ✓ No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes J_No Does the structure (s) on property have a valid Certificate of Occupancy? Yes ✓ No N/A 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? ✓ No Yes If yes,provide explanation: Project Description (use attachments if necessary): Gh)cye_r, Coop ! Eby �� o LQncl CeXred Or�v %C by NO1=1A 0r-Jenic.2g'i ff&dwe,tr©4 Run DrstQn c_e-f ern &O ck Cara n Q,1Ncutrn Rv\e� �. � ® � �I ` her5 Bo of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ra'(yy-%end 1 LVN%C.Ae-v` &&p Fo Area of wetlands on lot: square feet / Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 3z feet JClosest distance between nearest proposed structure and upland edge of wetlands: 3.0 feet Does the project involve excavation or filling? J 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 removed or deposited: 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): Levet G'rot nL� — tN0 e, `� 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: perm -Par Clmc_\W� eoo e 18v n Project Location(describe,and attach a location map): Brief Description of Proposed Action: CV1tCA(, Lr\ Coot/ and R1.L11 C Qrk.gt'e..a 0 Qtn t C �b y No V, A 6'r-1gho(. 9 prr��c.�"Vn Ch,CkRh fence as® I y l het56k Cajta\f'rCe frurvn $act s Cyt`J¢t��c+nGL�� Name of Applicant or Sponsor: Telephone: �3i_a9�-?los�8 6en� -fMQyam) E-Mail: Irn\ of-G me, r ,k t KYA eoe.-(�rrn S I,uen Address: -X30 S0\At/6 V i�et-d p►Je. City/PO: State: Zip Code: M kik k�k f kf 1155,)- 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that F may be affected in the municipality and proceed to Part 2. If no,continue to question 2. u 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: M ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban Rural(non-agriculture) ❑Industrial ❑Commercial El Residential(suburban) ❑Forest Agriculture El Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 0 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 0 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES u If the proposed action will exceed requirements,describe design features and technologies: R ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: Imo/ I ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: [A ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.Is the proposed action located in an archeological sensitive area? 171 1 ❑ a 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? Z ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur qm,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest [Z Agricultural/grasslands ❑Early mid-successional ❑ Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO RVV by the State or Federal government as threatened or endangered?16.Is the project site located in the 100 year flood plain? NO 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO If Yes, Ela.Will storm water discharges flow to adjacent properties? [�NO DYES b.Will storm water discharges be directed to established conveyance systems(ru ff and storm drains)? If Yes,briefly describe: �NO [—]YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? / If Yes,describe: © ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: ❑ I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor name: 2vvxo J > Date: LlixipI t C, Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? u 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 3. Will the proposed action impair the character or quality of the existing community? El 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or E]affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate �j ❑ reasonably available energy conservation or renewable energy opportunities? I 1 7. Will the proposed action impact existing: ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage 1:1problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print 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) PRINT Page 4 of 4 rd of Trustees Applicati< County of Suffolk State of New York � '�� -1'1� ry 9,k � IBEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL 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 BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL, TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. c 'gnature of Property Owner SWORN TO BEFORE ME THIS +h DAY OF Air► 2015 TRACEY L. DWYER NOTARY PUBLIC,STATE OF NEW YORK Notar Public NO.01 DW6306900 Y QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,20! APPLICANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: I'v \ N%InI4 LLC i b06 r a• ei G vy)J (Lait name,first name,4iiddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate.the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other',name the activity.) PrP r On%�' —C1n 'oop R%Jrj. Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the 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 indicated. 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 officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate 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 Submitted this OL _ Y a of ` 20d, Signature t Print Name .¢n• S Form TS l : Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold 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 Hazard Area. 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 Southold 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 LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listinji both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP 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# 166 - - 3,-1 PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees L"J 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation, land transaction) ❑ (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: i 0 C h 1CKQn Coop. I 1 by Ito L,-YJ Ce,rVAexp Cn1C,"V-. _,, 6�101rA � B Orc3GtQ1tiC. P.,C�� lUc r.c�►VC-}'ioYl V Yl ( a-® D s\-qv1c.Q- -Oc-orn 90A Gcc rel Co v►vznNc.-raI ChIckeV-, f enc.2, a50' L `k*-Yly • p Location of action: -X3V 30 So v'rnCA V t,e Site acreage: S' 7 D Acr C� Present land use: Aq r c �V r Present zoning classification: Pr-C. 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: "64 r yn S 1 co r 9gieve -%mg tt 4 nv% v(@)k,1 (b) Mailing address: aa-30 SO u rAV vel Ay e .� rfr-.t'k+ ltiGA(+ (c) Telephone number: Area Code 0) X%- 7 (d) Application number,if any: Will the action be e directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No LJfIf yes,which state or federal agency? 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 Southold 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 LWRP Section III-Policies; Page 2 for evaluation criteria. ❑Yes ❑ No M Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria 1:1 Yes 1:1 No 1_ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No ❑✓ 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 S through 16 for evaluation criteria ❑ Yes ❑ NA Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria ❑ Yes ❑ No Not 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 LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. ❑ ❑ LJ N I A Yes No /Not Apl ble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No[�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 LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No u 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. ❑ Yne�---1 No[A Not Applicable Attach additional sheets if necessary WORKING COAST POLICIE, Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. S e LWRP Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 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. ❑ Yes 1:1j No � Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. F] Yes 1:1 No u 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. ❑ Yes ❑ No 9 Not Applicable mar(,ene, 'FA r Wr 3 PREPARED BY D06r-�iGnr" -f EQrievie TITLE_Mq hS (y' eyY�jQr' DATE_ MarGene Farms J rsl 0fpniC Pro:fum April 16, 2015 ATTN: Board of Trustees We are writing this letter in regards to a recent chicken coop that was placed within 100 feet of a man made pond. The pond was dug out by my grand fa ther Frank Krupski and his neighbor John Robinson. The original purpose of this pond was dug out as a water hole for cattle. During the summertime the pond dries up and there is no water in it. The land that the chicken coop is on is agricultural zoned. The size of the coop is 12' by 14' in size and it has an attached chicken run that is 20' by 12'. We are an organic farm business that recently decided to raise organic chickens for eggs, so we can help supplement our organic vegetables for farmers markets and restaurants. We are requesting that we receive a non-jurisdiction letter from the board so we can proceed with the permit process through the building department as an agriculture building. Note: The building is not a permanent structure, however this was the only area we could place the chicken coop that is organic land approved by NOFA- New York. We have attached picture of the coop and run for your review. We also attached a paper size survey for review. /Yid- "_I�- '►1�✓�-t�(c *ugene & Ma ann Kru ski Maryann p MarGene Farms 2230 Soundview Avenue Mattituck, NY 11952 margene.farms5@gmaii.com APR 17i (631) 298-7688 ' �.O o0 xqnS 7noz F.z inr S.C.D.H.S. REF. j RIO-06-0031 I':-AUG-0.6 JAT .. -r:�: =...03, J ' �.j "—j'53 APR 1 7 2015 IC ........... 11 P.LOCATION uwlo%v) tAOUt4l k' GORDON l' N/O 322-Od A I Mr. 1 22.5'1 7J'I 8D' I L.P. 44 lag b5 SY 'No L5 -7 KEY MAP SCALE.•l'--600' If I ---j SUBDIVISION OF KR UPSKI FA MIL Y LC AT MA TTITUCK TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. 1000-100-02-03 SCALE.• 1=100' FEBRUARY 24, 2005 JUNE 15.2005 JULY 24 2005(REKTONS) JANUARY 24 2006 AUGUST 1.2006(FOUNDATION LOCATION) TMCAL WELL VNE 20,2007(FINAL) (NOT To SCALE) Ln TYPICAL PLOT PLAN (NOT TO SCALE) z FOP 11 t1l s Lr�oum root I/ ROAD TEST HOLE DATA t fill AREAS LOT 1=63,551 aq ft.or 1.4589 Acres LOT 2=55.9985 ACRES TOTAL AREA-57.4574 Acres THIS is To CERTIFY THAT THE SUBDIVISION PLAT HAS BEEN APPROVED A00 BY THE PLANNING BOARD OF THE TOWN OF SOUTHOLD BY RESOLUTION -.1,13 OF APPROVAL DATED % BY CH4IRMAN PLANNING BOARD I HEREBY CERTIFY THAT THIS SUBDIVISION PLAT WAS MADE FROM ACTUAL SURVEYS CoMpLFTED p124105. THAT ALL MMWNTS SHOWN THUS 0 ACTUALLY EXIST AND THEIR POSITIONS ARE CORRECTLY SHOWN AND ALL DIMENSIONAL AND GEODETIC DETAILS ARE CORRECT WC91VED JUL 25 2007 JOMLLT.MCTZGLP,NYS.LS.LIC.NO.49618 H.un amwa C.D=d.mg. I HEREBY CERTIFY THAT THE WATER SUPPLY(S)AND/OR SEWAGE DISPOSAL SYSTEM(S)FOR THIS PROJECT-- ONcs WERE DESIGNED BY ME CR UNDER MY DIRECTION. BASED UPON A CAREFUL AND THOROUGH STUDY OF THE SOIL, SITE AND GROUNDWATER CONDITIONS, ALL LOTS, AS PROPOSED, CONFORM TO THE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES CONSTRUCTION STANDARDS IN EFFECT AS OF THIS DATE. DATE SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES HAUPPAUGE, N.Y_ DATE .JOSEPH FTSCHETTI, P.E. LIC. NO. 052510 THIS IS TO CERTIFY THAT THE PROPOSED REALTY SUBDIVISION OR ZONING DISTRICT. A-C DEVELOPMENT FOR IN THE FIRE DISTRICT.- JO WITH A TOTAL OF LOTS WAS APPROVED SCHOOL DISTRICT' 9 ON THE ABOVE DATE. WATER SUPPLIES AND SEWAGE DISPOSAL U77LI77ES FACILITIES MUST CONFORM TO CONSTRUCTION STANDARDS IN EFFECT PRIVATE WELL AT THE TIME OF CONSTRUCTION AND ARE SUBJECT TO SEPARATE INDIVIDUAL SEPTIC SYSTEM PERMITS PURSUANT TO THOSE STANDARDS. THIS APPROVAL SHALL BE ELECTRIC VALID ONLY IF THE REALTY SUBDIVISION/DEVELOPMENT MAP IS CABLE DULY FILED WITH THE COUNTY CLERK WITHIN ONE YEAR OF THIS DATE. CONSENT IS HEREBY GIVEN FOR THE FILING OF THIS MAP ON WHICH OWNERS/APPLICANTS: THIS ENDORSEMENT APPEARS IN THE OFFICE OF THE COUNTY CLERK IN THE KRUPSKI FAMILY LIMITED LIABIL7y COMPANY il ACCORDANCE NTH PROVISIONS OF THE PUBLIC HEALTH LAW AND THE 1055 OREGON ROAD SUFFOLK COUNTY SANITARY CODE. MATTIIUCK, N.Y. 11952. SPSgOF P.E. MeTl)l CONTOUR LINES ARE REFERENCED TO THE FIVE EASTERN DIRECTOR, DIVISION OFENVIROMENT QUALITY TOWN.';TOPOGRAPHIC MAPS. - ANY AITERADON OR ADD1770M TO THIS StJRVT7Y IS A WOLA77ON OF SECTION 7209OF THE NoN YORK STATE EDUCA770M LAW. EXCEPTAS PER SECTION 7209-SUSDIV1S10q 2 ALL CER71FICA DONS HEW CW ARE VALID FOR THIS MAP AND COPIES ntFR'Or ONLY IF SAID MAPOR COMES SEAR 771C IMPRESSED SEAL OF THE SURVEYOR 1+110SE SIGNATURE APPfANS HEREON. CONIC S RVEYO 31) 765-5020 FAX 631 765-1797 P.O. Box 1230 TRAVELER S— . �05-102 SOUTHOLD, 11971 MouNT pOH L �uoA�.�ON R�� �"... Hsc. s'poo 4►�\�`4 ��, N SLE UNKNpWN ' .�5 , 80 ' 322.00 74.27.000 65 1 ' 5° o . ` °� 90 SUBDIVISION OF 60 <Pr ✓ a I� �/ LL co� - , I JP 'y SK[FAMIL rye, ► —�,� �o�s A T .?If.A. T TI T UCK 0 4 Q\� 1 !, 3 S � 05�o wE TO YjrlV OF' SO UTI—IOLD o� w i I'R T T,-Inl"y T 1�T rv� y `, 99 aF.RE 15� N t r V e.�i .,;y .sJ U 1 Y 1 1 V . . jim1000-100-02-03 / OF TRUSTEES BOARD SCALE: 1 '-100' `�- HUB I i ` � °� �'' �—,� -- TOWN Of SOUTHOLD FEBRUARY 24, 2005 \ JUNE 15 2005 I // �� /r ��c DATE �O Jul 23, .,4'005(revisions) os e \\ / JULY , 2006 (CER-TIFICA TIONS). I �-� \ so z AUGUST 4, 2006 fl-OC.. FND 17. I I ' ONG ND /SLA SOU \\ * I \4 -SOUND \ VIrw J`� -- \ \ \\ 15 , SO .. F I _ <q,� GQFsr I �},•w —�� � Nob / %5 60 KEY MAP S/TE c \\ \ I \ SCALE, I 600' I Ir 16 J / OREGON ROAD ZONING DISTRICT: A-.0 x \ _ 60' \ FIRE DISTRICT, 30 �� SCHOOL DISTRICT, 9 x � 71 GREA TER AREAS OF'SLOPES OF I5/ OR x\ 6 \ SOIL. CL-11 'SIFIC SUFFOLK COUNTY SOILS CLASSIFICATIONS \ HOB,HOA, M1B,P18, PmC3,HdB,RdC R SdA x \ \ x \ \ Z 0 UTILITIES PRIVATE WELL x\ \• \ INDIVIDUAL SEPTIC SYSTEM \ \ � � � Z - ,ELCCER/C. x\ \ \ 0 CABLE. TEST HOLE \ \ uo L + •7/06/05 \ BYMacDONALD GEOSCIENCE K \ z BROWN LOAM OL BROWN SANDY SILT ML \ 6' x it O F��D t, BROWN CLAYEY SAM SC x ,Q x \ PALE BROWN FINE TO ` COARSE SAND SW \ 4T THIS IS TO CERTIFY THAT THE SUBDIVISION PLAT HAS BEEN APPRO.V�ED• \ BY THE PLANNIN G BOARD OF THE TOWN OF SOUTHOLD 3Y RESOLUTION OF APPROVAL A x \ \ BY90 CHAIRM NN PLANNING BOARD \\ \ � �1 2 \ 1 HERBY SURVEYS COMPLEITEDSUBDIVISION 02• PLAT THAT ALL MONUMENTS ro \ \ \ S MADE FROM ACTUAL \, SHOWN THUS a ACTVALLY EXIST AND THEIR POSITIONS ARE x\ \ CORRECTLY SHOWN AND ALL DIMENSIONAL AND GEODETIC DETAILS \ \ ARE CORRECT. �� `_' x\ \• JOHN T. METZ={GER, N.Y.S. L.S. LIC, NO. 496re x \ x \ \ COUNTY DEPARTMENT OF HEALTH SERVICES \ \ SUFFOLK \ \ HAUPPAUGF_, N.Y. HOP, \\ DA TE r �^ i:EirTfFiEG TO, THIS lS' TU CEIiiIf`Y T)IAi THE PROPOSED REALTY ovOU/INITHEvr� MACGRE•GOR ABSTRACT,,INC. x \ DEVELOPMENT FUR WITH A TOTAL OF—LOTS WAS APPROVED CHEVY CHASE BANK \ \. ON THE ABOVE DATE. WATER SUPPLIES AND SEWAGE DISPOSAL EUGENE KRUPSKI FAC/UTIES MUST CONFORM TO CONSTRUCTION STANDARDS /N EFFECT MARYANN KRUPSKI \ TO SEPARATE_ \ \ � � \ \'•�_ • / \ — _� - - �' ^\� \ AT THE T/MF_ OF CONSTRUCTION AND ARF. SUBJECT PERMITS-PURSUANT TO THOSE STANDARDS ,THIS APPROVAL FE SHALL BE VALID ONLY IF THE REALTY SUBDIVISInN 1. 9•Dx� \ DEVELOPMENT MAP 1S DULY FILED THE COUNTY CLERK \ \ WITHIN ONE YEAR OF THIS DATE. ! x� 50' \ CONSENT IS HEREBY GIVEN FOR THE FILING OF THIS MAP ON WHICH THIS ENI>ORSEMENT' APPEARS IN THE OFFICE OF THE \ \ COUNTY CLERK IN ACCORDANCE WITH PROVISIONS OF THE PUBLIC HEALTH LAW AND THE SUFFOLK COUNTY SANITARY \ \ CODE. ' P.E. \ • DIRECTOR, DIVISION OF ENVIROMENT OUAUTY I HEREBY CERTIFY THAT THE WATER SUPPLY(S) AND/OR SEWAGE DISPOSAL \ \\ \ i SYSTEMISI FOR THIS PROJECT WERE DESIGNED BY.ME OR UNDER MY DIRECTION BASED ON UPON A CAREFUL AND THOROUGH STUDY OF THE SOIL SITE AND GROUND WATER CONDITIONS, ALL LOTS AS PROPOSED CONFORM fO THE OWNERS' APPLICANTS SUFFOLK COUNTY DEPARTMENT' OF HEALTH SERVICES CONSTRUCTION., „ \ THE KRUPSKI FAM1L Y LIM1 TED LIABILITY COMPANY #/ STANDARDS IN E7 FECT AS OF THIS DATE. —_ _ \ 150 1055 OREGON ROAD MATT/TUCK, NEW YORK 11952 :,JOSEPH FISCHET TE, P.E. \ � t " \ Nd8 •\ � p , PROPERTY LME AREAS LOT t= F.�,551, ' sq.f1'. or ,I.4589Acre -- Wc. LOT 2 = 55.9985 CRFs TOTAL ACRES= 57,4574 ACRES \ Ate sALLAN ' \ � � HOUSE \ o As _ \ �� v, I \ E \ �\ O,OU• / N I \ n v w WN SE1+71C TAAK t iROZADWAT ��' / C'• I \`\�� v�•�\ /J Y St INrt �, 1 ala- cwY POK / / MUS LF1�C1048 POOL S"E^°N 5� tAll \ n 10 Aw \ a TYPICAL WELL ° �, t�g Q \� \ AD NOT TO SCALE) �J \ ROAD ( f \ \\ 5p3�3 0 0 \� O I C� S TYPICAL PLOT PLAN z• `� --- ------ FR£. 0 0 • "5 \w � ,�� I too" �. g' v � !•P\ i' AU // ���1 li� �' � d NSE y Q� i /\\ Ad, PJ�� wt' LOc. ri10 tt UOgrr 65• . 001 0 a � 0 g01 O I g6• 0 t \ i �1pEl 0 o� Q J P P 50`�� �\ �lol�0` 0 ���O� ,tQ��pF NEK,10 5'oRN ��ETzc`���r 01 N N .9618 \ 0 � PCCONI C IRE R q- ALTERATION OR ADDITION TD THIS SURVEY IS A NOLATION 0cP0�� ���� \ ANY (631) 765--50 Gf' .1797 OF SF-CTION 72o90F THE NEW YORK STATE EDUCATION LAW & ESOP F'.O. BOX 9)9 S� EXCEPT AS PER SECTION 7209-SUBDIVISION 2. ALL CERTIFICATIONS HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF ■ =MONUMCNT CONTOUR LINES ARE REFEREPICED TO THE tO�J 1230 TRAVELERS E.L./�� --102 SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR ® ==PIPE FIVE EASTERN TOWNS TOPOGRAPHIC MAPS SOUTHOLD, N. Y. 11971 WHOSE SIGNATURE APPEARS HEREON. M � i - I I