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Home My WebLink AboutTR-5393 ill lill;3* .. i Board Of Southold Town Trustees SOUTHOLD, NEW YORK b. DATE August ,30, 200 ' i PERMIT NO. .. ANN DOBSON...CLEMENTS...................................................... « ISSUEDTO ................................. . . Pursuant to the provisions of-Chapter 615 of the Laws of. a; 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- " a titled ."REGULATING AND THE PLACING OF OBSTRUCTIONS IN AND ON TOWN WATERS AND PUBLIC LANDS and the MATERIALS FROM REMOVAL OF SAND, GRAVEL-OR OTHER LANDS UNDER TOWN WATERS; and in accordance with the Resolution of The Board adopted at a meeting held on .Aug•. S Z991., and in consideration of the sum of $........50..Op.._.._ paid by r Ann Dobson Clements A - ♦ ..... .... .y .................................... ....................................... .. - Southold of ..:-::....... N. Y. and subject to-the .... ..... ... ' Terms and Conditions listed on the reverse side hereof, 1 �= i of Southold Town Trustees authorizes and permits the following: _ Wetland Permit for aground -level• (grade) wooden patio approx. / kr 1 20' square attached to existing screened-in porch of house. `ya \ all in accordance with the detailed specifications as presented in Iy the originating application. `r The said Board of Trustees here- IN WITNESS WHEREOF, by causes its Corporate Seal to be affixed, and these presents to b a ma'ori of the said Board as of this date. ' be subscribed y I tY fi` FFD , j w C= Trsutees Fl �� •}� `Y � _ _ _r �. �. � -s=��cc•.—��--.. 7. -=ter-�,.T=r'�:`,r-``" `�--�-a-F`.. '` / .;.�: TERMS and CONDITIONS Ann Dobson Clements The Permittee residing at 345 West 13th St. , #3A, NYC, NY 10014 N. Y, as part-of the consideration for the issuance of she Permit does u¢derstand and prescribe to the fol- lowing; i. That the said Board of Trustees and the Town of Southold are released from any and in damages, or claims for damages, of suits &rising directly or indirectly as a result of ay open- . . atioa performed pursuant to this permit, and the said Permittee will, at his or her own expense, - defend any and an such suits.-inidated by third parties, and the said Permittee asom" fill liability with respect thereto, to the complete exclusion of the Board of Trustees of the Tows of Southold 2. That this'Permit is.valid fora period of 24 mos. which is Considered to be the estimated time-required to Complete the work involved, but should.dr&xwmces 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 auth- orization was originally obtained. . 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-oompliance with.the provisions of the originating application,maybe cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigadw as a result of the work herein authorized. 6. That here 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 wotk herein authorized, or if# in the opinion of the Board of Trustees, the. work shall cause unreasonable obstructton to free navigation, the said Permittee will be fequlred, upon due notice, to remove or alter this work or project herein stated without expenses to the Tows . Of Southold. 8. That the said Board will be notified by the Permittee of the conVedon_of the work autr orizcd 9. That the Permittee will obtain all other permits and consents that may be required sup- plemental to this permit which may be subject to revoke upon failure to obtain same. ...-..-cam. Albert J.Krupski,President VFFD( Town Hall James King,Vice-President O`,�S �CQG 53095 Route 25 �Z' y� P.O.Box 1179 Henry Smith a .c Southold,New York 11971-0959 Artie Foster N Z Ken Poliwoda �y • Telephone(631)765-1892 Fax(631)765-1366 �01 � Sao • BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD August 30,2001 Ms. Ann Dobson Clements 345 West 13t' Street,Apt. #3A New York,NY 10014 RE: 560 Ruch Lane, Southold SCTM#52-2-25 Dear Ms. Clements: The Board of Town Trustees took the-following action during its regular meeting held on Wednesday,August 29,2001 regarding the above matter: WHEREAS,ANN DOBSON CLEMENTS applied to the Southold Town Trustees for a permit under-the provisions of the Wetland Ordinance of the Town of-Southold, application dated July 16, 2001, 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 August 29, 2001, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS,the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, WHEREAS,the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, 2 RESOLVED,that the Board of Trustees approve the application of ANN DOBSON CLEMENTS for a ground level(grade)wooden patio approx. 20' square attached to existing screened-in porch of house. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Permit to construct and complete project will expire two years from the date it is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Two inspections are required and the Trustees.are to be notified upon.completion of said project. Fees:None _ Very truly yours, f � Albert J.Krupski, Jr. President,Board of Trustees AJK/lms Bldg.—Dept. — -- DEC �... T ' qC N/F BARNES _ N 34•• 5—•.-E 185.26' cu N i ip c4e& cJ7 z) ar-4m 10+Ksq y !'--. ' NYrf S •v �{ � ov v / 6 Q) 3 i19' slips p i l STORY r WOOD ,tom saps ` FRAME W ,� •Q O ��i RES. Z ti (WOW) p CANACC 1 7�� S 3 2.0" Ia.• 7.5 r5 16.3,801, IAcC•4.Rc FV I _ Go/ All 1000-052-02-25 SURVEY OF DESCRIBEO PROPER T Y SURVEYED 17 AUGUST, 20( S/,rUA rE SCALE 1"'30' ARSHAMOMCOUE (SOU THO(.D), AREA- '7,9os.sJ3 Sr TOWN OF SOU THOLO 0.411 °ACRES SUFFOLf; COUNTY, N. Y, SURVEYCp F� lQV 003SOIV CCEMENr S w•w.uvrrZs «acArzb Mtpt a+ vAu puN SUR n°°'t� rH(�saY rov ...[,,,, na svR►cr VE1'ED 9Y aw w s 9CNA(� rp $•TA NC E Y GUAR m M �• • s z� �(�[ RAN rQ c�vti/t [tshar n,[ [,. nfnr�now ✓. /S/IfCSEN AO '70-4 wsm/ 5 Wsa["'v:( ro P.O. Bo;( 294 ANN DOBSON CL£MfNTS sxw(H/ owcRs NE F10EL IY NA nONAL RTL r trrAu nraq.rro .0 rCA•n�,, cw A n 19_` INS CO. s . aa,!no, or uc[,°a °" ro nlrf 631 -7;.t 5�3✓ lfw 3"'r ttivcw MW cr ra,, uw r co"WS or i.• s�*Kr WAP n r r ''� e`i"OCw T*�S twOn•,yU r: Lc ICE yr �/�` VAIIV' N/..7 •�`' ^//^, . ----- ,,, 4• f A.NN DOBSON CLEMENTS July 12, 2001 Board of Town Trustees Town of Southold P.O. Box 1179 Southold, NY 11971 July 12, 2001 F JUL 1 6 20M Dear Lauren, Please find enclosed my new application-for aYTrustees permit for a wooden patio at my home on Ruch Lane. I am sending 2 copies of all of the application paperwork but only one copy of the stamped survey as per our conversation yesterday. Many thanks for your kind assistance. Best regards, Ann D. Clements 34S W.13'Street,Suite A New York,,New York 10014-1207 VOX 2i2.807.oggg FAX 212.807.0998 CELL 917.8o6.S434 email:anndc[ements@aol.com Ff0�co Town Hall; 53095 Main Road rra 'T P.O..Box 1179 Telephone O . �� , Southold:Near York 11971 (631) 765-1892. SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council.held Monday, August 20, 2001, the following recommendation was made: ANN DOBSON CLEMENTS.for a ground level (grade) wooden patio approx. 20' square attached to existing screened-in porch of house. 560 Ruch Lane, Southold. SCTM#52-2-25 The CAC did not make an inspection, therefore no recommendation was made. Albert J.Krupski,President - O��FFO(�C Town Hall James King,Vice-President ��0�' ��jy 53095 Route 25 Henry Smith P.O.Box 1179 o Artie Foster Southold,New York 11971-0959 Ken Poliwoda %G `F Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 30, 2001 Ms. Ann Dobson Clements 345 West 13th Street,#3A New York City,NY 10014-1255 Re: 560 Ruch Lane, Southold SCTM#52-2-25 Dear Ms. Clements: The Board of Trustees took the following action during its regular meeting held on Wednesday, April 25, 2001 regarding the above matter: WHEREAS, ANN DOBSON CLEMENTS applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated March 27, 2001 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 April 25, 2001 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, NOW THEREFORE BE IT RESOLVED, that the Board of Trustees Disapprove the application of ANN DOBSON CLEMENTS to construct a ground-level wooden patio approx. 15' attached to the existing screened-in porch of the house,based on the applicants request to withdraw the application at the present time. However, the Trustees permit the applicant to re-vegetate the bank with Rosa Rugosa, or other wetland species, in order to stabilize the bluff. BE IT FURTHER RESOLVED that this determination should not be considered a determination made for any other Department or Agency,which may also have an application pending for the same or similar project. Very truly yours, (� /Gr • ;00;. Albert J. Krupski, Jr. President,Board of Trustees AJK:lms cc: Bldg. Dept. t r -NOTICE Police Dept. - Bay Constable w " Town of Southold LAAn Peconic, New York 11958 ;,: `- 2001 �:i� � NOTICE OF VIOLATION Date: 'PjOwch 3, 2001 To: Ann Dobson Clements (Owner or authorized agent of owner) Address: 345 Nest 13 th St. , 3A, New York, Pi.Y. 10014 (Address of owner or authorized agent of owner) Please take notice there exists a violation of the Code of the Town of Southold, Chapter 97 Article II, Section 97-20 a premises hereinafter described in that you are conducting operations within 100 feet of wetlands without first obtaining a Southold Town Trustee Perrin t. You are therefore directed and ordered to comply with the following: Cease all further work on deck and clearing of wetlands. Apply for a Trustee Permit for work already done. on or before the 30 day of March 720 01 The premises to which this Notice of Violation refers are situated at: 560 Ruch Lane, Southold, N.Y. 11971 Town of Southold, Suffolk County, NY (Suffolk County Tax Map Designation: Dist. 1000 Section: 52 Block: 2 Lot: 25 ) Failure to comply with the applicable provisions of the law may constitute an offense punishable by fine or imprisonment or both: NOTICE: You have the right to apply for a hearing before the Board of Trustees of the Town of Southold, provided that you file a written request with the Clerk of the Trustees within 10 days after service of the Notice of Violation. Such request shall have annexed thereto a copy of the Notice of Violation upon which a Hearing is requested and shall set forth the reasons why such notice of viola- tion should be modified or rescinded. Bay"Constable, Town of Southold, NY _ Town of Southold _ Town of Southold A 16 6 Suffolk County, NY a 16 61 Suffolk County, NY The People of the State of New York vs. The People of the State of New York vs. LAST NAME(DEFENDANT) FIRST NAME MIDDLE INITIAL LAST NP ME(DEFENDANT) FIRST NAME MIDDLE INITIAL CL E M+✓N TS (�,.�N D CL t:n i`r-3 R u u b. STREET ADDRE S 319 APT.N0. STREET ADDRESS , I .NO. 77 T•1 CITY STATE ZIP CITY STATE ZIP faltrw `lvZA, u..11. id01i/ IdEw -/otiAC, N.Y. i00/y LICENSE OR REGISTRATION NUMBER .UCENSE OR REGISTRATION NUMBER STATE TYPE OF LICENSE DATE EXPIRES SEX DATE OF BIRTH OPERATOR STATE TYPE OF LICENSE DATE EXPIRES ISEX DATE OF BIRTH OPERATOR M�J� �Y� �F OWNS VEHICLE MO OWNS VEHICLE /f seLri OYES ❑NO ❑YES ❑NO THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BELOW THE OPERATOR OR REGISTERED OWNER OF VEHICLE DESCRIBED BELOW PLATE NO. DATE EXPIRES PLATE NO. DATE EXPIRES STATE PLATE TYPE STATE PLATE TIDE ❑N.Y. ❑N.J. ❑N.Y. ❑N.J. ❑ ❑PASS ❑COMM ❑ ❑N.Y. ❑N.J. ❑N.Y. ❑N.J. ❑ ❑PASS ❑COMM ❑ VEHICLE MAKE ❑ DODGE VEHICLE MAKE ❑ DODGE ❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC ❑ BUICK ❑ CHEV ❑ CADILLAC ❑ PONTIAC ❑ FORD ❑ OLDS ❑ PLYM ❑ FORD ❑ OLDS ❑ PLYM ❑ TOYOTA ❑ VOLKS ❑ ❑ TOYOTA ❑ VOLKS ❑ BODY ❑ 2 DR ❑ 4 DR Cl BUS ❑ MCY Cl S.W. BODY ❑ 2 OR ❑ 4 DR ❑ BUS ❑ MCY Cl S.W. TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑ TYPE ❑ TRUCK ❑ TRAILER ❑ VAN ❑ VIN NUMBER VIN NUMBER THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLLOWS PLACE OF OCCURRENCE PCT PLACE OF OCCURRENCE PCT sE,C 2L'"I 2uC-tt Lr+^j>r Osrs- DATE O OFFE E AM TIME PM CITY.TOWN.VILLAGE,OR HAMLET SUFFOLK COUNTY NY DATE 0 FFEN A TIME PM CITY.TOWN.VILLAGE,OR HAM ET SUFFOLK COU N, a rSdu'r't+4�� ° IN VI TIO OF SECTION SUED. OF THE❑VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK IN VIO TON IV SECTION SUED. OF THE❑VEHICLE AND TRAFFIC LAW OF THE STATE OF NEW YORK P&HER(SPECIFY) ❑O.S. ❑COM ❑BUS ❑HAZ 34-ER(SPECIFY) ❑O.S. ❑COM ❑BUS ❑HAZ• Z „ �,�,4 r., D E F VEH MAT `�-(�.. �� 3"� DEF VEH MA, ❑ SPEEDING I OTHER OFFENSE ❑ SPEEDING OTHER OFFENSE MPH IN A MPH ZONE MISDEMEANOR ❑ MPH IN A MPH ZONE MISDEMEANOR❑ FACTUAL PART(NOT FOR TVB) nq FACTUAL PART(NOT FOR TVB) (� THE ABOVE NAMED DEFENDANT DID ON THE STATED DATE,TIME ANO PLACE 1f4PJ DU1L' - THE ABOVE NAMED DEFENDANT DID ON THE STATED DATE,TINTg AND PLACE 11 _ 1 rUII1CAV PEC 10 pFJe.�T►o us A t�.e.�t 1 *t-t►,� i o� i;`�' aF- VY►rH t IU /00 Fr o F WtTi -5 K1-i-r+ouT VJ�xLLaws�+�,5 uLtrr��— T2vs7F� F n,r►<<-' `nw% ,tE. F .►��z" PvP$u �— ro 4�-.� The Foregoing is Gazed on(personal knowledge) The Foregoing is based an(personal knowledge)and/or(ntonnston&belieQ,the source being the attached sworn deposhion(s)of dated dated PARKING SCHEDULED FINE$ CONTACT COURT❑ PARKING SCHEDULED FINE S CONTACT COURT C THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT THE PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 SOUTHOLD TOWN JUSTICE COURT,53095 ROUTE 25,SOUTHOLD,NY 11971 �.�..DDIIE OF APPGMNCE RIOT FOUR TTVW L <!rA t t'� GATE OF AIPP`EARANCE(NOT FOR TV8) ) �' t 0 l ON c"r,-T•Vei� 3 r/ AM k AT ALvwF. ON M•�'RICi 7{ �(9 Q�Lo o L AT Ar,VfS FALSE STATEMENTS HEREIN ARE PUNISHABLE ASA CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE P.LN.Y.S. FALSE STATEMENTS HEREIN ARE PUNISHABLE ASA CLASS A MISDEMEANOR PURSUANT TO SECTION 210.45 OF THE P.LN.Y.S COMPLAINANT DATE COMPLAINANT DATE 3 01 3 3 d1 q` BADGE r 5.e— rl� BADGE M COURT COPY COURT COPY = Town Nall; 53095 Main Road '�►� P.O. Box 1179 Telephone `Y Southold.New York 11971 (631) 765-1892. SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Monday, April 16, 2001, the following recommendation was made: . Moved by Bob Ghosio, seconded by Bill McDermott, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of 'the Wetland Permit Application.of ANN DOBSON CLEMENTS 52-2-25 for a ground- level wooden.patio approx. 15' attached to existing screened-in porch of house. 560 Ruch Lane, Southold The CAC recommends Disapproval because the proposed deck is too close to the edge of the bluff, which would promote erosion. The CAC recommends re-vegetation of the bluff with an approved planting plan. Vote of Council: Ayes: All Motion Carried ----------- 45,"1 7 A E: 3 j Is 07 s 71 E 9.HBO. y\ 'PS CX-41-011.E _ SECT]N NO L Nonce OUNTY OF SUFFOLK J.,K SOUTHOLD L Red Property Tax Service Agency E '_ -. �.. r • ••..� y ai ts�'„S4f {-F:�µr f.'�vr�f'�'t'''C� lY ^t�•,+."�'�,�`ir _ _ _ ,r , '. ; # t •� L' - �- �'.� .;� :gip ' :11'1 J /�•��-.��:l/��[l w.y�L `' ~'�rL t! `� '.. Y•�•f � - {r , �t.;�( _ '� �/'�) _lam. = ."� ,r_. ,g�1�`�„ �. �I�_.� .: ':fig'. ..- !' '�j_ .t•i "" ,r... � - A-A .x5^ty%.'/d~ ''= .•�,3. �y''�'��', ji♦-'�;-!" - '�t*-s-". �.. '��=��7' ,~ 4 �,.rs}r�, .,.� -T ^�N•N,•�. - •�yl vr.<5x u• nJ �w i��•!Y� ♦r'{ .�a��.f M,,�G •'� •l � C J �: '-. ., !• [: .i.•jTGr``'t •J r yi�.l _� �`t. / } •�''r`R r )�kl �i .•',�,,1�`-s}' •.f1i.� i 1 �' Albert J.Krupski,President OSVFFO(�C Town Hall James King,Vice-President �� Gy 53095 Route 25 P.O.Box 1179 Henry Smith o= y Southold,New York 11971-0959 Artie Foster C Ken Poliwoda • Telephone(631) 765-1892 y�01 �aO� Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application /Wetland Permit Application Major /Minor _Waiver/Amendment/Changes deceived Application: deceived Fee:$ /Completed Application _Incomplete 5: _SEQRA Classification: p ': Type I Type II Unlisted ', JUL 1 6 no0 Coordination:(date sent) {,�" .,-CAC Referral Sent: .--Bate of Inspection: _Receipt of CAC Report: Lead Agency Determination: - _Technical Review: '°public Hearing Held: b1 Resolution: Name of Applicant A W Address 7 N/p S 1 1 It/tul7T3lq C co/ Phone Number:( Suffolk County Tax Map Number: 1000- do o 60 6J CC C dt 0o) Property Location: S� l�L ��he, JOA 61 (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: bl KJ�, Area of wetlands on lot: 3 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: (P S feet Closest distance between nearest proposed structure and upland edge of wetlands: GCS feet Does the project involve excavation or filling? No Yes i If yes, how much material will be excavated? �d cubic yards How much material will be filled? d f cubic yards Depth of which material will be removed or deposited: id feet Proposed slope throughout the area of operations: U --,- 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): Y, Board of Trustees Application GENERAL DATA / Land Area(in square feet): d. /I s Area Zoning: t�J/ `� �r I v►' Previous use of property: Intended use of property: rilhyl C(V� 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): qr,�k, Le&� Anak) tODdikxo�lb a�nlnvoy- J0, s iMj ee— 7� i Soh sch°OGt _1 Board of Trustees Application County of Sti#fe& Del;vt�JID� State of New York Anj (iC' (dMellfS BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED., IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S)OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. r`! Signature SWORN TO BEFORE ME THIS DAY OF 20 d -Notary Publi VEER A. G=TI COMAMSSIONER Of DEEDS City of Now York, No, 1-2723 Cerh Cmn xpir in w York N �J Commission Expirer 14-16-4(2187)—Text 12 PROJECT I.D.NUMBER 617.21 S EQ Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT ISPO!!�O�c�N � � � I 2. PROJECT NAME 3. PROJECT LOCATION: 3`+ ,,l CJ'J_ V Municipality U 0 �, County Lqjh�K 4. PRECISE LOCATION(Street address address and" road intersections,prominent landmarks, etc.,or provig p) S(o / 1V(i� LQk-P-_� TM sz --oz -- )-,S 5. IS PROPOSED ACTION: ❑New xpansion ❑Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: uee • :. a,p �,� Q?f NYC-�.�.e� �o ��c�s17'� ed'�- 7. AMOUNT OF LAND AFFECTED: Initially 60 54 acres Ultimately acres d. WILL P90POSED A T1 N COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? ❑Yes KyNo If No,describe briefly 9. VJ JHT ❑ ❑IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential Dridusuial Commercial Agriculture L;Park/Forest/Open space L i Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL,OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STAT E LOCAL)? es ❑No If yes,list agency(s)a'n'dp'ermitlapprovals ------------- V 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? , Yes' ❑No If yes,list agency name and permit/approval 7awi,` Sow dt C bu)diJ� pew rr- !SJ ut t 12. AS A RESULT QFIPROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MOOIFICATION? ❑Yes o I CERTIFY THAT THE INFORMATION PROVIDEED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor nam �,r 00�soq v' c� J Date: 9 SI nature• �� If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER i CART II—=NVIRONMEN i SMENT i i o be completed by Agenc' A. DOES ACTICN Ei -ED ANY t f?E i THRESHOLD IN.S NYCRR, ?..RT 317.t2? ;f yes. cocrainate the review process and use the F°:!L_ _-AF. Yes No B. •NILL..CTICN RE'Cc;VE CCCRCINA7c7 RE'/IE'N AS PROVIDED F•::R UNLISTED ACT;CNS iN o NYC=R. ?ART 517.5t it tto, a negative dec:ara may be sucers e� oy anctner;nvolvea agency. I_ yes JN.No C. COULD ACTION RESL'L'tN ANY ADVERSE EFFECTS ASSCC:ATED WITH -�E FOLLOWING:fAnswers may be nancwntten, if ;egtble) C1..Existing air quality,.3ur,'aca or'groundwater cuality or quantity, naise Ieveis, existing :raific patterns. solid "Haste )recuc:icn or also potential to erosion, drainage or:loading problems?Exctain brierty: ho CZ. Aesthetic,agricultural, archaeological,historic,or other natural or cultural resources:or community or neignbernood cnaracter? Explain qr 4o C3. Vegetation or fauna, fish. snellfisn or wildlife species,significant napitats,or threatened or endangered soec:es? Excla(n ortalty: C». A community's existing plans or goals as officially adooted,or a change in use or intensity of use of land or other natural resources?Explain or hO - C5. Growth, subseduent development,or related activities likely to be induced by the ar000sea action? E.xcla(n onefty. CS. Long :erm, snort term,•cumuiative,or other effects not identified in C.-CS? Exclaln 5rierty. Aa i other;moat:s iinc:ucing c::anges in use of either quantity or type or energy)? ==)tarn oriefly. I D. ;S 7HERE, CR i — ERc L:KEL'f'O SE.=NTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL;tdP.ACTS? Yes 'No !f Yes. explain briefly i PART III—OETERMINATION OF SIGN IFiCANCE (To be completed by Agency) INSTRUCTIONS. For each adverse effect identified above,determine whether it is substantial,large,important or otherwise signific. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b)"probability of occayng; (c) duration: irreversibility;(e) geograonic zcooe:and (f) magnitude. If necessary, add attachments or reference supporting materials. c-nsure ' explanations contain sufficient derail to.snow that ail 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 ;nd/or prepare a positive•declaraticn. I ChecX1 this box if you have determined, based on the information and analysis above and any supoortinc i documentation, :hat the.proposed action WILL NOT result in-z�.ny significant adverse environmental impacts i AND provide on attachments as necessary, the reasons supporting this determination: i i ' N.,ufd nr LCrU Agency i !nnt u( ovpe N.rfnf, 31 <esoonsiaie l;tlfcef:n.eao AgenCV tf(1C of -(vioonssoie Ufffcer ffC 2f) -;fgnilule-31 1Csconsfore'�t:fcef,n :eta AgenCy ifgnature or err.-jarer tlr ::ft:efent tra re5oonsfole:It t ' Ja(c • 2 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address : CERTIFIEDU.S. Postal Service U.S. Postal Service CERTIFIED MAIL RECEIPT MAIL RECEIPT (Domestic Mail Only;No insurance CoverageProvided) I (Domestic Mail Only, • insurance Coverage Provided) Ln zA 'T' PlEW YORK- N1' 10 01 4' UTH. II "' ` ' m 4 197.1 Iv Postage $ Q� n: 0054 ti Postage $ 0.34 UNIT III: 0054 � Certified Fee � � � Certified Fee 10 ostmark fl_I � Postmark Return Receipt Fee O®r Here Return Receipt Fee �y Here 0 (Endorsement Required) —0 (Endorsement Required) ry cnm Irk. KJk41T ✓U KJ"4FT O Restricted Delivery Fee p Restricted Delivery Fee O (Endorsement Required) 9Q, C3 (Endorsement Required) <N 01 g Total Postage&Fees -O �11�tJ1 t3 Total Postage&Fees $ n •4 /. 7�11)t} [_ "n Sent To L r Sent To 6 , --------------------------------------------------------------------------------------------- ------------------ In Street,Apt.N or No. Street,Apt.No.;o x ------------------ - ----------------- -------- -------- ---- ----------------------------- ------------------------ ---------------------- City State,ZIP City,State,ZIP+4 � d / /L/ PS Form :00 bbo :00 000 leverse 74rl n-...ns, STATE OF NEW YORK COUNTY OF S4FP&L-K- AN 6. COU eh_. , residing at 3 S U 37kJf /0 O/V , being duly sworn, deposes and says that on the _ day_ of c.Jl ,�9 2zoj, 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 aid Notices were mailed at the United States Post office at that said Notices were mailed to each of said per dons by (certified) (registered) mail. Sworn to b foe his ll day of Notary Pok j(.CGOf U®EEDS No,1-2723 C. of New York, w rk City Y C.e FicaM filedol Com •sVon ExP A NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: SCTM#1000- YOU ARE HEREBY GIVEN NOTICE: ° 1 . That it is the intention of the undersigned to request a Permit from the Board of Trustees to:. I U 1 2 . That the property which is the subject of Environmental Review--is located adjacent to your property and is-, described as follows : �— Sov`7k //I r7 l 3 . That the project which is subject to Environmental Review under Chapters 32 , 37, or 97 of the Town Code is open to public comment on: / 22 You may contact the Trustees Office at 765-1892 or in wri ing. -The above referenced proposal is under review of -the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal . OWNERS NAME: f�hv� MAILING ADDRESS : 34S W . 13111-Jf- N C. i a0N - 2 SS PHONE #: 2.lZ $0 —09ckct Enc. : Copy of sketch or plan showing proposal for your convenience. uFFo� Albert J.Krupski,President Town Hall James King,Vice-President � .53095 Route 25 r/y� Henryith P.O.Box 1179 �' o Southold,New York 11971-0959. Artie Foster C Ken Poliwoda Telephone(631)765-1892 41- �a Fax(631)7654366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ------------------------------------ In the Matter of the. Application of COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING' r �p I �ab �•-�� r residing at �S t-✓ • � 3dd� C t being duly sworn, depose and say: That on the 12-•day offU - , 200 , I personally posted the property ]mown as S*f 0 WUCft L Are by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in 'place for eight days prior to the date of the a�► ar ublic hearing. Dat of hearing- noted thereon to be held Q.W. oraw,4 -7-,do • Dated: j signature) Swornnyy to before me this `6 day of 0 0 C U Notary Public HELENE D.HORNE Notary+Public,State of New York I No.4951364 g0alified in Suffolk County Commsssion Expires May 22, a 0 P Albert J. Krupski,President OSUFfO(�C Town Hall James King,Vice-President �� r/y 53095 Route 25 Henry Smith o= P.O.Box 1179 Artie Foster Southold,New York 11971-0959 Ken Poliwoda Telephone(631) 765-1892 Fax(631)765-1366 �c BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application ;/ etland Permit Application Major Minor Wdiver/Amendment/Changes ,,�Rece_ived Application: 10( Received Fee:$ Completed Application ') 1 Incomplete _SEQRA Classification: MAR 2 7 LUUI Type I Type II Unlisted Coordination:(date sent) SAC Referral Sent: 3 a"10l _✓Plate of Inspection: q\y� l _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: _✓fublic Hearing HeWL-'JJAS1b1 Resolution: Name of Applicant 14A y Dyh S o h Cl o (°Gl fS Address 3 k ejr 3 �"- Jf/l�� ---t314 - Phone Number:( Suffolk County Tax Map Number: 1000- pe,06h 62 0D 8 K W.0p Lot U-C-00 Property Location: Roc/ /'�'h e 6/A d t 6("W � (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application q GENERAL DATA C Land Area(in square feet): / S ,. U ae'5 /n n Om-e'dfvco Area Zoning �sl �C`e�-1 ( �X ��-9 -- ' U Previous use of property: Intended use of property: S 1 Ak C-0— Prior permits/approvals for site improvements: Agency Date V/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): i 7 v r 1.6-1.6-4(2/87)—Text 12 PROJECT I.D. NUMBER 617.21 SEQ. Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART ]—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME h h !)As -v C('e[M S i0 1-- 3. PROJECT LOCATION: �7 Municipality soom County S/' (�/ 4. PRECISE LOCATION (Street address and road intersections,prominent landmarks, etc., or proviad map) 7M o s_L-. 5. IS PROPOSED ACTION: ❑New ,Expansion [I'Moditication/alteration 6. DESCRIBE PROJECT BRIEFLY: ✓v✓k�- l�v l�vor,Pt h �c i'o 4�)J)V-vy. I S 5 V6.►Ile 7. AMOUNT OF LAND AFFEC; :.,e. - Initially `U�S Ultimately y "' acres 8. WILL PROPOSED JACT ION COiv114LY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? C Yes L,A No If No.describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? Residential [1ndustrial Q Commercial ❑agriculture i—!Park/ForestlOoen space LJ Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE iR LOCAL)? IKp�f Yes ❑No if yes, list agency(s)and permit/approvals /y(vSl''e e of cvt r 1 U s . 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Yes' ^` ❑No If yes, list agency name and permit/approval �v(l�t�'� ill�s/GLtr� ��h1r��(Ji,✓!.( '� �JO��I� . 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes Nb I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE / Applicant/sponsor name: r / '+ V` / "ok) `�! v�Mt� Date: 11yL/ IN Signature: If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 APART II—=VVIRONMENi,_-1 SESSMENT Fo be cornoiete , oy Agenc, A. GOES AC-'.CN EXCEED NY I I?E i THRESHOLD IN o NYCRR, P.%nT Si7.'Z? If yes. cocrainate the review process and use the FLILL _x1F. El Yas No B. WILL ACTICN REZZ i' CCCP.GINATcO REVIEW AS PP.C'JICE]Fin UtlLiSTEJ.� TICIVS iN 3 VYC?R, PART 51 i.5? if No. a negative cec:ara may be sucerse ed oy another involved agency. (_ Yes 4-No C. CCULO ACT ON RESULT IN ,ANY ADVERSE E==cCTS ASSCC:,ATc]'.VI T H -HE*=0LLGVJING.'Answers may ce nandwrltten. if ;eglble) Ct. existing air quality, surface or'grounawater quality or ouantity, raise Levels, existing :raific patterns, solid waste proauc"on or alscc potential for erosion, orainage or;loading problems? E:olaln brieily h C2. Aesthetic, agricultural, arc;Iaeological,historic, or other natural or cultural resources:or community or neignbernaod cnaracter? Exolain o, 'ti O CO. Vegetattllon or ;auna. :Isn. snellfisn or wildlife species, significant habitats,or threatened or endangered scec:es? Explain orlally: C;. A community's existing plans or goals as officially adopted,or a cnange in use or intensity of use of land or other natural resources?Explain :;r A � C5. Growth, subsequent:evelooment.or related activities likely to be induced by:the orocosed action? =xoialn arfefly. Ao iCS. Long :errrim, snort term.•cumulative,or other 3tfec*,s not identified in C:•CS? Exclafn onefly. I other im/oac:s iinc:ucing c^anges In use of a!ther quantity or type of energy)? =:ptatn -rieily. I 'J. :S -HERE.0R ' ERE L!KEL'.' TO BE.CONTROVERSY RELATED TO ?OTEENTIr.L ACVERSE =:IVIRCNPAENTAL:,',',PACTS? i _ Yes 10 if''es, explain brieity PART III—CETERMINATION OF SIGNIFICANCE (To be Comoleted by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large, important er othervise signific. =ach effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occasing; (c) duration: irreversibility:(e) geographic scope: and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure exotanations contain sufficient deiall to snow that all relevant adverse impacts have been identified and adequately addressed. Check this box if you have identified one or snore potentially large or significant adverse impacts which tAAY occur. i hen proceed directly to the FUEL =_.A andlor prepare a positive-declaration. 1 Check this box if you have determined, based on the information and analysis above and any sU. Orsin- i documentation,, :hat the proposed action IPJILL NOT result in_ ny significant adverse environmental imoac:s I AND provide on attacaments as necessary, the reasons supporting this determination: I I N„111e fit '-c,d AgenCY I i !rent if :vpe `.line at <cioommie I:Iticer:n ;ejQ Agcncv :Itle of :<,,i0ons.0le Utflcer I l f 71Ceri "griatum-)7 escomiwe• Agency )Ig� nature Jf e.7+ lrer;Ira 117:erenr from 'e50on5101 r, J < �I:ICCf n :C3O 1 tnC i'.' 1 JJfC c: Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: rQUV1 U�l (O fo ews y\� ,V64-v r(_�fffd-- \J Area of wetlands on lot: �j �'OD square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 30 feet Closest distance between nearest proposed structure and upland edge of wetlands: (oS feet Does the project involve excavation or filling? X — Yes If yes, how much material will be excavated? D cubic yards How much material will be filled? ' 0 cubic yards Depth of which material will be removed or deposited: o feet Proposed slope throughout the area of operations: d 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): PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Postal ! U.S. Postal Service CERTIFIED MAIL RECEIPT CERTIFIED MAIL RECEIPT (Domestic Mail Only; . Insurance Coverage Provided) (Domestic Only;No r, I �, Coverage , . .. - Provided) C L7 NEW41MK NY i001 � SDUTHOLID, N 119 , ;� 11 Postage $ OZ4 UNIT ID: 0054 m w � Postage $ 0.34 UN q l�, Certified Fee — t ru 1.90 ��PW H c i j ti Certified Fee 1.90 QO�11 Return Receipt Fee Q G� '�'/f S I os •••0 (Endorsement Required) Q �` e �/ J Return Receipt Fee Were\ C3 ��"9 (Endorsement Required) O Restricted Delivery Fee Cle U KRGJGO O Restricted Delivery Fee ■ p (Endorsement Required) ` 7p ■ ,� ry C ■Q( j']��1 4� ' ' O (Endorsement Required) J� i o Total Postage&Fees $ 2.24 03/t6/0 0 �. 1 1� I Total Postage&Fees $ t� Sent To / R �� Sent To Dh e �/- J C r ' qq /1 �J 1:3Street A o.: r Bo o. J�1 1—; .......tree............................... No. - -- Ciry,Sta + /Uv / ,Q�C i Cl CI Sta �V PS Form :00 May 2000See Reverse(/or instructions, L _ .,, See Reverie for instructions STATE OF NEW YORK ` COUNTY OF SUFFOLK Aj)h o)) Cif e-NraS residing at 3�fS l✓• 13�Si-. �3ft- �� being duly sworn deposes and says that on the . day of 1kL&-c,4 — ,1-f jo f, 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 Notices were mailed at the United States Post Office at 9` ,"ItY, /UVC— , that said Notices were mailed to each of said pers ns by (certified) (registered) mail. Sworn to before me this Z� day of IAkae� , T'�0 Notary Public / VINCENT G.NOONAN,JR. Notary Public,StatO of NSW Vb* No.31-5001775 OudIfled fn Nawi Comridasion Explrea Board of Trustees Application County of wwk1� `I0�•�� State of New York A)q ao 6jon ( 'd Im r I/1 �S BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF c ,200/ 1 c,,.�• Iv Notary Public VINCENT G.NOONAR JR. Notary Public,State of Now Yo* No.31-5001776 assion E hpire Commission Exire