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HomeMy WebLinkAboutTR-5488 - fO(�- Albert J.Krupski,President S�f 0�� C� Town Hall James King,Vice-President = GZ� 53095 Route 25 Artie Foster 'p P.O.Box 1179 Ken Poliwoda a Southold,New York 11971-0959 Peggy A.Dickerson �ifi� ��� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD January 21, 2004 Mr. &Mrs. Jason Luhrs 1175 Hiawathas Path Southold,NY 11971 RE: 1132 CHESTNUT RD., SOUTHOLD SCTM#59-3-16.5 Dear Mr. &Mrs. Luhrs: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, January 21, 2004: RESOLVED that the Southold Town Board of Trustees grants a One-Year Extension to Wetland Permit#5488, to install a stone driveway to the garage. This is not.an approval from any other agency. If you have any questions,please do not hesitate to contact this office. Sincerely, Al#ertftarups?,�r. President,Board of Trustees AJK:lms tj Southold - Town Trustees: Board t_ , '• SOUTHOLD. NEW YORK b. .ti. DATE: Feb. 21•;..:2002 = %, PERMIT NO. ... • .. ii C r`. JASON & LISA LUHRS `1 ISSUEDTO ................................. . . . . . AntI I ton • ` Pursuant to the provisions of Chapter 615 of the Laws of. 4 r 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 ."REGULATING AND THE PLACING OF OBSTRUCTIONS h IN AND ON TOWN WATERS AND PUBLIC LANDS and the REMOVAL OF SAND, GRAVEL-OR OTHER MATERIALS FROM LANDS UNDER TOWN WATERS;": and in accordance with the Feb. 20 •� Resolution of The Board adopted at a meeting held on ........................... . 2002 200.oo , and in consideration of the sum of $............................. paid 6 y Jason & Lisa Luhrs ........................................................:...........•........ a - ...............................g...........-.................. - h3 :> Virginia ................................ W2?. and. subject to the of .......................................................... Terms and Conditions listed on the reverse side hereof, ' of Southold Town Trustees authorizes and permits the following: z' ' ;�• ' Wetland Permit to install a stone driveway to the garage. F all in accordance with the detailed specifications as presented in . the originating application. The said Board of Trustees Mere- . IN WITNESS WHEREOF, - by causes its Corporate Seal to be affixed, and these resents to be subscribed by a majority of the said Board as of t is date. Ke t Poliwoda..- Absent Trustees ` TERMS and CONDITIONS Jason & Lisa L_uhrs The Permittee 9725 Virginia Centerway Pl. #104, Glen Allen VA )MYU; as residing at part. of the consideration for the issuance of the Permit does understand and prescribe to the fol- lowing: lowing: i. That the said Board of Trustees and the Town of Southold are released from any and all damages, or clainhs for damages, of suits arising directly or indirectly as a result of any oiler- anon performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits-initiated by third .parties, and the said Petmittee assumes full liability with respect thereto, to the Complete'exdusion of the Board of Trusties of the Town of Southold 2. That this Permit is'valid for s period of 24 mos. which is considered to be the estimated time•required to complete the work involved, but'should cirdaistances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to'maintain the structure or project involved, to provide evidence to anyone concerned that auth- orization was originally obtained. i 4. That the work-involved will be subject to the inspection and approval of the Board or its agents, and non-compliance'with.the provisions of the originating application, may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. G. That there shall be no interference with the right of the public to pass and repass alothg the beach between high and low water marks. 7. That if future operations of the Town of Southold require the.removal and/or alterations . in the location of the work herein authorized, or if, in the opinion of the Board of Trastees, the. work shall cause unreasonable obstruction to free navigation, the said Permittee will be requited, upon due notice, to remove or alter this work or project herein stated without expenses to the Town of Southold 8. That the said Board will be notified bq the Permittee of the Completion.of the work auth- orized. 9. That the Permittee will obtain all other permit and fcoe mts 6at way be required t obtain same. �' plemental to this permit which may be subject p� Albert J.Krupski,President Town Hall James King,Vice-President O$QFFO�/�'C 53095 Route 25 z 0� O P.O.Box 1179 Ken Poliwoda � Artie Foster Gy Southold,New York 11971-0959 Peggy A.Dickerson y Z Telephone(631)765-1892 Oy �� Fax(631) 765-1366 col � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD February 21, 2002 Mr. &Mrs. Jason Luhrs 9725 Virginia Centerway Place#104 Glen Allen,VA 23059 RE: 1132 Chestnut Rd., Southold SCTM#59-3-16.5 Dear Mr. &Mrs. Luhrs: The Board of Town Trustees took the following action during its regular meeting held on Wednesday,February 20, 2002 regarding the above matter: WHEREAS,JASON&LISA LUHRS applied to the Southold Town Trustees for a permit under the provisions of the Wetland Ordinance of the Town of Southold, application dated January 15, 2002, 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 February 20, 2002, 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, 2 NOW THEREFORE BE IT, RESOLVED, that the Board of Trustees approve the application of JASON&LISA LUHRS to install a stone driveway to the garage. 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, Albert J. Krupsr, Jr. President,Board of Trustees AJK/hns o = Town Hall'. 53095 Main Road c� 'T P.O. Box 1179 Telephone O O Southold. New York 11971 (631) 765-1892 SOUTHOLD TOWN CONSERVATION ADVISORY COUNCIL At the meeting of the Southold Town Conservation Advisory Council held Tuesday, February.12, 2002, the following recommendation was made: Moved by Drew Dillingham, seconded by Bill McDermott, it was RESOLVED to recommend to the Southold Town Board of Trustees DISAPPROVAL of the Wetland Permit Application of JASON & LISA LUHRS to install a stone driveway to the garage. Located: 1132 Chestnut Rd., Southold. SCTM#59-3-16.5 The CAC recommends Disapproval of the application because the project was not staked. Vote of Council: Ayes: All Motion Carried 01/02/2002 15:03 804-270-5"- KAREN WILSON SF INS PAGE 01 11 Q JAN — 2 '''�' To: Lauren Fax: 31-765=1366 From: Jason Luhrs Dale: 1/2/2002-" Re: Letter for Heal h Dept. Pages: l4 w/cover CC: I ❑ Urgent ❑For Revi m 0 Please Comment 0 Please Reply 0 Please Reey0e e } e the cop es of the survey and the letter frorn the Health Dept as we ed'+earlier. The Health Dept. would like wetter from the Town Trustees 1 + g the wetland . In the body of the letter lease use the Health Dept. reference number. Z working with Judge BruO arxd this matter is time sensitive because the property contract is contingi I ent on several pertxxits. Your help in this matter wo ild be greatly appreciated. ' Thank you. 1© d3 Sincerely, /Jason Luhrs I 01/02/2002 15: 03 804-270-F KAREN WILSON SF TKIC3 PAGE 02 WWM-042 (REv. 5/2000) s►nr..em SUFFOLK CO DEPARTMENT OF HFJLLTH SERVICES OFFICE OF WASTEWATER MANA EMENT UFFOLK COUNTY CENTS t .AD,NEw YORR 11 01 631-852-2100 NOTICE F 0,—;P V TO H.S.REFERENCE NO.: D e'" PR PERTY LO AT10N: S Al el 40 The plans for your proposed sewage disposal and wat,x supply systems have been reviewed and the following will be required prior to further processing of the application for approval to construe, PLEASE RETURN A CO OF THISFORM M I N. N ; CHANGES TO p EMAID] BY A ARCHITECT OR ENGINEER),. 1, A R V L -g=f AGENCrES [ J N.Y.S.Dept.of Env.Cons. [ ] Sewer District Approval [ ] SEQRA Determination [XJ Town Wedands/DrainaguZoning [ ] S.C.D.H.S.Vector Control [ J Other 2. PLAN Dj&yA Amp INFoRmAiloN RE UIRED [ ] 3 prints-of plan required with [ ] Indicate on plan the specific [ ] Indicate any surface waters within design professional's original locadon(s) [with measuremen ]of 300'of plot;show wetlands limit as stamp aad signature All water supply wells&septic flagged by NYSDEC and/or Town [ ] ApplicaRion Fee:$ systems(within 150'of all [ ] Show area for 50%expansion of [ ] Name,address,phone no. property lines)or state if dwe ings sewage disposal system [ ) Statement signed by applicant . are connected w public water [ ] Show test boring&location on [ ] Indicate area of lot(sq.ft.) [ ] Show proposed house/driveway plans ( ] Corner elevations location on plan [ ] Test boring inadequate. See [ ] S.C.Talc Map Number required [ ] Show proposed sewage dlspa al Remarks below. [ ] Surrounding property-vacant or system/water supply well/wa ( ] Grading plan showing invert improv4d (within 150'of all service line on plan elevations of sewage disposal property lines) [ ] Test well required on your lot as system foundation and final grade [ ] Retaining,wall must be designed per attached bulletin (by licensed design professional) by P.E,or R.A. [� Submit letter from water district [ ] Public sewer stub location from [ ] See enclosed Form W10VM-043, indicating distance to nearest ublic sewer district shown on plans Notice of Non-Conformance water main and availability 3. OTHER 1►#, RKS O�1 S C Gt -14 _EUR T F�-_TEPRZPAPXD (��j O/ By 1 1 Jason Luhrs 9725 Virginia Centerway Pl. #104 Glen Allen, VA 23059 (804) 553-1480 Southold Town Board of Trustees Southold Town Hall 53095 Route 25 i Southold,NY 11971 JAN (631) 765-1892 Dear Board of Trustees, I would like to take this opportunity to address some issues that may be beneficial to this application. I have highlighted two areas of concern on the wetland/trustee lands application data form. I have in essence guessed the area(sq. ft.) of wetlands on the property. I have walked the property several times since the completion of the survey. According to the survey by Joseph Ingegno, the property indicates wetlands. However, the concrete marker on the southeastern most part of the property to the southwestern most corner has no wetlands. I did locate a very small area of wetlands, but feel that the wetlands are well over 100' to the proposed driveway and on the property of Venetis. The purpose of this application is to address the 100' conservation easement. As the survey indicates, the proposed driveway infringes on the 100' easement by approximately 10' for a very limited area. The driveway will be aggregate/stone and will have no environmental impact on the wetlands. I am requesting a possible waiver if the Board finds that the current proposal is adequate and does not require the issuance of a wetland permit. During your field observation, the best possible entry on to the property would be from the SCWA water house (access from Kenney Road). There is a path that runs parallel to the property that will give you access. The other possible entry would be to walk behind the small white house at Chestnut and Hickory Road. The house is on the south side of Chestnut Road. Your approval of either a wetland permit or waiver would be greatly appreciated on the first public hearing on February 20, 2002 in which I will be in attendance. I currently reside out of state and the property transfer is contingent on all required fields for the issuance of a health permit. Mr. Rudolph Bruer is my attorney if any legal questions should arise. Sincerely, Jason Luhrs N SEE S EC.NO." 054LM •L�' fi 2 •) �T V.:R 9 797 --11-OU i-o2-Oo 0 r Y /, :` �J yp a��' ry< i �q+.r �+ A O 9 Pb o aA 9 28.4 r s .5c r g� ry .. 9 `°'♦P�0, '° n♦F ^;• a 5,t `ryb tiby `I' 21 F -✓2 ° IJ `O Jy - ®r •Y F ,� '� t1 j 2LU(.) .* a ®r8 P `� � � � JS �. .r LJSG � a §R eFb/ ,°' 4 a ♦ ,ry, a 261 F E� ho2,,+ r s +sJ y/�.r/ap "• ryr r y 17.fiA n` �Tv 5 �`� O� s 2 rr+'+"• , J67� �09 P,"b c Q:14 9.1 E Yy`4 C Iv'i \ plc c\p` ♦° � � - B.t : ' �-- :4 4�2�. ��T � •ry♦ -.� g/r� RR / r •* �zs cy i vla•i 30.28A%cl �r ° vim'is`O��C j / p4' E ST.NO. : &3 OF 6 ..L0 ry^^' P �•a > ti \" y` c, gy P offs-e:-9oLoos I I "'_� / "ss ° o Ctt,' A• s O GREA-POND rOTx <� \ \ ��� /f �' �o'c/ *, d`6 Ei •h?N I "ta`':,. 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N.A Nnkf un --°-- )an.nr Osrr[,lA.--..-- AmaArn iA51E1ATFA I.RIM rISf 1FN PWti50N Oa TN: Mop IDe fx A 1L1 AM Tcw y" --- --6-- I l L PAORAIT TAX SEANCE ACD1 . P ae S �v. 9to lOOO PROPERTY MAP CONYFRSAYI DATE-.Aw.241F5A • • � SURVEY OF s LOT 4 MINOR SUBDIVISION PREPARED FOR �•s o� RHR REALTY CO. ` " .¢, >r� FILE No. 8811 FILED SEPTEkIBER 13, 1989 '9 ' s SITUATED AT SOUTHOLD �, TOWN OF SOUTHOLD C,� `'Z o SUFFOLK COUNTY, NEW YORK '& �+ c S.C. TAX No. 1000-59-03-16.5 SCALE 1"=100' OCTOBER 22, 2001 1•\ \ s n AREA = 131,969.2E sq. ft.�C , ar \ `tip 3.030 ac. JAN APPROVED "'i" I BOAR® OF T�aU T '��,�, �y,0 1. ELEVATIONS ARE REFERENCED TO AN ASSUMED DATINI 7C ;p COMM ELEVATIONS ARE SHOWN TMIS: 1aQ 's • 2. REFER TO FILED MAP FOR TEST HOLE DATA. TOWN OF S O U T H O L D �S: ,`\ r S. YMR1 II SIFIX TANK CAPACITIES FOR A I TO 4 BEDROOM HOUSE IS 1.000 GALLONS. /� I TANK: 8' LONO, 4'-3' WIDE, I'-7' DEEP \7f �B• `\. 4. MRIINUM LEACHING SYSTEM FOR A I To 4 BEDROOM NOOSE IS 300 p n SIDENALL AREA. I POOL 12' DEEP. 8' dla. A_ O PIS EXPANSION Pm C3 PROPOSED SEEM TANK \' �>O S. THE LDCAII7M OF WELLS AND CESSPOOLS 5I1aWN HEREON ARE FROM FIELD •6 OMERVATIONS AND/Olt 1. FOUNDGRCONC.ED MOIL::IN W DATA OBTAINED FROM OTHERS. SET corAw t ` 9 reo sac ♦6A / O f, low Cem e4f Avn()Me4� / LlJ1LS:'MO AND ADDFlID TITLE lit STALE 1AID Au *i. 410 i s ` w UNPARMOROS'D ALTERATEDI OR ADDITION N.Y LJo. No. TO THIS SURVEY Ei A VIO AT011 OF y"G�� • ° 1' �"� STATE SWIM NEW `Of THIS SURIOW MW NUT� Joseph A. Ingegno •oG d•�o O •31� THE LAND am SIX O �R — FO EMBOSSED SEAL MV"NOT BE CONSIDERED G�f� o�� ?0s ��QSS TO BEA 1MLD TILE COPE. Land Surveyor G BUJ CEII1C OM Imam MIEMI 1 SHALL RIM 15 P lD M AND O HS WAVY T70 S1A1YlY 6 PRETAIIA ND pl MB 80Wf 7D THE • es A1� Txb SWVNP - SL**A bm - Sib Poor - Canbucum Lamd Sp YAP A DOPOUL.SEMMS ON GE RG FOR " TUMOR. AM�° E p (631)727_20/0 Fax (831)727_1727 �GIItI03 PAPADOPOUI,OS do GEORGE YARAGOS Flip M THE OFFICE OF THE CLERK OF surFm catom THE E10SiF I r Or I1011T OF WAYS r1�1•�LOT �I�'�+1� ON st[F7oncl a. ION AS FlE Nw U1: Alo/o� usEMons or R[cow. a aFtlr�s enrlTEv�r wt,��ooralss VACAPfT ANT, NOT SIIOwN ARE NOT 611A WffRzD. 1380 F49M AYEMIE P.O. 9= 1231 RIVG*EAD, Nw York 11901 Rlwlrod, Now Yak 11901-�866 I , I - i • l jam 440- Ive / y a _e I . FJAMECEOV =f�2�0 Southold Town Board of Trustees � i uFFO�Albert J.Krupski,President QS �C Town Hall 0 53095 Route 25 James King,Vice-President Henry Smith P.O.Box 1179 y Southold,New York 11971-0959 Artie Foster W Ken Poliwoda • Telephone(631) 765-1892 *4 �a Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application / Major Minor 113 0 a _Waiver/Amendment/Changes I Received Application: i Received Fee:$ 88O k ' _completed Application D _Incomplete r _SEQRA Classification: MW Type I Type.Il Unlisted JAN 1 5 )un? Coordination:(date sent CAC Referral Sent: 0� 1(g- /Date of Inspection: /3/Dp _Receipt of CAC Report: _Lead Agency Determination: _Technical Review: __ Public Hearing Held: Oy Resolution: Z. Name of Applicant a6orl4 Address Q7aS &�1?11'a \J O/e, I Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: 113 e0lul lal, SAO/ &u Of eS n rYJI. fcross e(provide LILCO Pole# distan a to streets, and loc ion) AGENT: /� � (If applicable) °-- Address: Phone: Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: ()A)]( Previous use of property: "aca Intended use of property: 0,64s L-Nd 5;,4 /C ;l A6C,&- -j Prior permits/approvals for site improvements: Agency Date N No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspendo by a governmental agency? No Yes If yes, provide explanation: w ----z ' ' Project Description(use attachments if necessary): ludu IsLe, aln&.4hillQrzt ury A/1 I ateS 2 QD ' 0oP1Se PG e e Ili es �Q � Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: PrOAL a Q e e Area of wetlands on lot: square feet See, 49d ed Percent coverage of lot: % �QlO�roS(,�_�veSS Closest distance between arest existing structure and upland edge of wetlands: n feet Closest distance between nearest proposed structure and upland edge of wetlands: TS- j0 feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? �/ cubic yards How much material will be filled? / cubic yards Depth of which material will be removed or deposited: feet or less Proposed slope throughout the area of operations: JJ � Manner in which material will be removed or deposited:Aallt';o zer an 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): 1.4-16.8(2187)—Text 12 � PROJECT I.D. NUMBER 617.21 SEO Appendix C State Environmental Quality Review SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART I—PROJECT INFORMATION (To be completed by Applicant or Project sponsor) 1. APPLICANT/SPONSOR 2. PROJECT NAME zV A/ V114 2 qa 3. PROJECT LOCATION: Municipality County d. PRECISE LOCAT ON Stree add oa ress nd rd intersections, prominent landmarks, etc., or provide map) 13z � lax I NO /40o-s9-03-16•S r ff 1 0r 5. IS PROPSED ACTION: r—t w ❑Expansion ❑Mod ificationlalteration 6. DESCRIBE PROJECT BRIEFLY: R,�S '�, p � ear- to Y r a ;��e driver Y ��al t v/-I-GK'�' I � /OdC' s 7. AMOUNT OF LAND e FECTED: I Initially acres Ultimately ? acres /o ) a. WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? a/Yes ❑No If No,describe briefly 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? �Residential t_ldndustrial ❑Commercial ❑Agriculture L Park/ForesUOpen space U Other Describe: 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY(FEDERAL, STATE OR LOCAL)) ❑Yes L14 No If yes, list agency(s) and permittapprovals `s - 11. DOES ANY ASP T OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes' No If yes,list agency name and permitlapproval 12. AS A RESULT OFPROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicantisponsor nam , D Date: 1-0 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 PART II--NVIRONMENTA' 'SSESSMc`11 i 0 be car ieten by yonC i A. 'CES AC iCN EXCEED ANy i -E i THRESH..OLC iN o NYCRR, ?AnT 5i7..21 !f yes. =ocrainats :ne review process ana use the FUL_ cxAF E!yes L'No B. WILL ACT!CN PECE:VE _CCP.CINA,ic]REVIEW AS PRCVICED =:R UNLISTED ACT!CNS iN o NYC'R. ?ART 517.5? if No. a negavve _ec:z may be sUoersedea ay another;nvolvea agency. Yes No C. C;ULD ACT.!CN ?ESUL'!N ANY ADVERSE °F?_.,TS ASSOC! TcC'LAITY. --E FOLLOWING.;Answers :nay oe nanawntten. if :egrbla) 11. Existing air gua!!ty, surface or'grounawater duality or auantity, raise levels, ex:sang :,aific oatterr•.s, solid waste prccuc:icn potential fcr erosion, grainage or Gooding problems?Exolain briefly-. C2. Aesthetic,agricultural, arcnaeologlcal, historic,or other natural or cultural resources;or comOlUnity or neignocrnootl cnarac;er? =xolain CO. Vegetation or fauna. asn. sneltfisn or wildlife soecies,significant haoitats,or threatened or endangered soectes? =zclam grleily: C_'. A community's existing plans or goals as officially adooted.or a cnange in use or intensity of use of land or other natural resources?Explai CS. Growth. subsequent 7evelooment.or related activities likely to be induced by the orobosea action? Exoiain ariefly. iCS. Long term, snort term,c:muiative,or other erfects not identified in C.-CS? Explain briefly. I i I i .,. Ctner imoac.s iinciuc!ng cnanges In use of a!ther quantity or type of energy!? =-main :;rieily. i I I 0. ;S 7HER E,OR!S 7HERE _:KEL.'TO SE.C CN T ROVERSY RELATED TO POTENT!AL ACOVERSE =NVIRONMEN T r.L if PACTS? i i _ Yes _ !o :f Yes. exclain ariefly I PART III—DEi caMINATION OF SiGNIFiCANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise sigi cacti effect snould be assessed in connection with its (a) setting (i.e. urban or rural); (b).probaoility of occa_—I,ng; (c) dura irreversibility:%e) geograonic scope; and (f) magnitude. If necessary, add attac:iments or reference supposing materials. E-ns exotanations contain sufficient detail to snow that all relevant adverse impacts have been identifies and adequately address Check this box if you have identified one or •nore aotentially large or significant adverse impacts Which ? _ occur. hen Proceed directly to the FULL EAF andfor prepare a positive-declaration. i Check this box if you have determined, based on the information and analvsis above and anv sucoot documentation,. :hat the procoseo action WILL NOT result in .fly significant adverse environmental ima i AND provide on attachments as necessary, the reasons supporting this determination: i i .V..ule Of ..cjU ASCnCY i .'nnt it :Yoe Vdinf! .i <eeQonsmie.:mcef:n tega �.Suncv title or `<v-oonsiole orncef I Board of Trustees Application County of Suffolk State of New York �QSon �j�j� 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. XL ZAXI Signature SWORN TO BEFORE ME THIS � . DAY OF 20� W Notary Public NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: 1 / k lasa�l i1al,�%sq ,Ly SCTM#l000- YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request/a Permit from the Board of Trustees to: �� e �DD� Co�tSeri/a��o�l 2�aSeace�� a �1 roXim� l /O' /,J�' I an a � �� S�ne� d r►Velva , 2 . That the property which is the subject of Environmental Review-ems located` ard'a ent to �DUA04�1 ouproperty and is described as follows : [13a Ci�t4� ul 40CA �. 3, 030 GC. y 3 . That the project which is subject to Environmental Review under Chapte 32, 37, or 97 of the Town Code is open to public comment on: _40 gol You may contact the Trustees Office at 765--1892 or in writing. 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: U M. !J MAI NG DRESS: 7 ' i C,+/ #/0�/ en v PHONE #: - SY - D C�,nt�T i� d�ee�-- vr�crCon Enc. : Copy of sketch or plan showing proposal for your convenience. Albert J.Krupski,President OSVFFO(�C Town Hall James King,Vice-President �.�0�► �r/y 53095 Route 25 Henry Smith o= P.O.Box 1179 Z Southold,New York 11971-0959 Artie Foster COD Ken Poliwoda • `F Telephone(631) 765-1892 yifJol �aO� Fax(631)765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD ----------------------------------- In the Matter of the Application of Jan �l�t'S0. M- -------- COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFIDAVIT OF POSTING I, �/f A vn �t�.�i'J � residing at 11971 being duly sworn, depose and say: That on the 8 day of �� , 200Z, I personally posted the property known as A - e ke�'i tL4 -, � ��l 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 o h u1bbliic, earin *. _nate f hearing noted thereon to be held Dated: nn (; ign ture) John Sworn to before me this NOTARY PUBLIC,Staateof New York day of �/�5 2002, No.01KR46M22-SuffolkCwe Term ExplrM Feb.28, �y ?ary Public SEE SEC.NO.OS< 1-01- WTCH �E , Y J z2{ 1-9-q 0 a rw-v �wv • v + $ .ae • °j hr 24 y�Y M1 " �Yi9b Q tr ,S �$i « ��i e 1 �vV l.J+��/1`�� SEE SMHl L10 'J , _ � e + '�a a b k '+ ' '�� �• 4 ,gYa,a y,` � 1 V ®U� , a 2 a O�? + s a to `• dye 2e.4 `I 4s7�•1'i.� �e � SIAA 1 1 '�l I 1 ' aO a sT •a \\ 3 l7 + � � O� • SO zs a s b t'+G ®~Bid ; / �•�e • e ,�� 17.61 � +`J —N— A,\ Y `~+ ,> e y GREAT PoNLAKEI A+ p �� • .25 v s.FFOIi cnllHn25 �Vr� � 0"',7a • �W� _ •ivy s sl ]O.BAta ryy / : 5. @ • O S e O 'Z.f`T 13 IT.SAW d J S -7 • ro RY J� •y+� +'• �a 6 WTOLK + Y COUNTY o alcros Rues vAm S> '� •�? ,Q °+yr" a 2t• a y,$ CI I JTSAIcI Y+e! � � 1�ci 6.3 1 •'m d�••�,. al \\O30.4 T v '1`oa O ^� �• 5a y y�, b •99\ LOAIcI am"'a ws `A d d � 1.aw z 4 20,2 M1 V 1JA $ T.01m ,4 COOHA M SOPFW. '/ El y v u a ate' z © e 5 ° , s 1 r FOR PARCEL N0. 120AW u u l I •✓ \�\ SEE SEC He.OU-01-009FOR PARCEL N1 SEE --Cow SEC m 059-0-005.1 9 vFo� \ W1CN lAE MATCH LW SEE SEC Na M 7 N SEE SEC N1069 •P M Ov0°� _ NoncE D COUNTY OF SUFFOLK E �, �' m "1MOF SOUTHOLD SECTION NO L many x m _ —_ maTsv OPAm mIER•nsG. Au Paaanrn S00Vn�m --`�— '°" • — -- '� '"" "` `a`°'�` "�iei Real Property Tax Service Agency Y E 9••n.rae Per --YZ— aAAab.mw•. (21) rr.•.mn e. --r-- m+M u. — sa•a 5[POl MAxrP.-1LTERAT K SIZE OR on ao PUAri OF 059 Y� O umyn �f11BIRIOO W ANT POR—6 TIE R«..ao•mm w—IrsT-- Pr• County Center RlveriMwd,N Y 11901 N ASE eaews•tN u. ------ wa•.�.>n m yr mae u• --•-- uort ATq AiiQll COum TAM MAP 6 PROIQPm , Hlhrw V nw. "^-'• sae m.m m mar u. = uM mIM u. --L-- //�mIM u.--A-- M• I•P A RPpP xmPEH vEwE.Sall aP TIE �• A as am m7ia7 to S�UU PROPERTY NPP D M.p a Awe ne 121 AIA or 17.fA I'^M+ -- P.+mIM Is. _ -- Mwe1r•nM u.—•n PE4 PFOMRTT TAR EERVRE AGM. SWE N REh P uar•.. 1LI)Ad P4IM x.r mlrtltti — mxroeal wtu rcxlPx PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS 4roMos Address: I� 'PO4:Uee,r5 PI)Name: L%miaAOs Q� 61C e,le, 77'(�j"y Tl� r STATE OF NEW YORK COUNTY OF SUFFOLK _� U ,residing atPF-5 i�le ps" ,being duly , depo es and says that n the � , _day of `�i1I ,20V, 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 assessmentXIC"LOA 1the T wn o Southold; that said Notices were mailed at the United States Post Office, that said Notices were mailed to each of said persons by (certified) (registered)maill.�//f�;;''. �eyncl �I 4rA PoSI CJf�'iZ Sworn to before me this Day of 20 Q)� �J Not Public 8�1-a7�-1�37 AP PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address:. CA I\�d - u.s. Postal Service ECEIPT hAijI�► Aver, 74,2 (Domestic • Provided) O o M NG 11792 I' Postage � Certified Fee $2.10 0145 ,� 10 Postmark rq Return Receipt Fee $0.00 Here fU (Endorsement Required) [3 Restricted Delivery Fee $0.00 O (Endorsement Required) Total Postage 8 Fees $ f2.67 01/11/2002 mmP Nae ease Print lean)(to be completed by mailer) ..� So_ri y Box t - ------------------------------ Er -ree,,�a Apt or PO r• ` v pt fffJJJ g at ,being duly sworn, dep es and says that the day of ,20_a, 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 Klfl 1 o the T wn of outhold; that said Notices were mailed at the United States Post Office at p ,that said Notices were mailed to each of said persons by (certified) (registered mail. 3 �� Sworn to before me this l� Day of ,2061 _ otary Public Y0�-,Z 70-1q3 I x x PROOF OF MAILING OF NOTICE ATTACK CERTIFIED MAIL RECEIPTS i U.S. Postal Service CERTIFIED MAIL RECEIPT Address:(Domestic Mail Only;No Insurance coverage Provicied) C3 akd ,1, lvd l . �� &9 m, E NY 11769 Er Er Po1$ $2.67 `° Certified 0145 � 10 - Postmark r� Return Receip Here (Endorsement Requ ru O Restricted Delivery M (Endorsement Requ i O Total Postage&F 01/11/2002 r 7 Name se Print Cle rly)�o be completed by mailer) R�1?ll__ 111/� -------------- Er styEr /yyetp�A�ptr.N r O Box No./�ie J,�' Ci te,ZI Jr���4 1<ti� �J / ,residing at 7 F-A Jvt( 644 p S' ,being duly swo , s and sayse da of ,20 , 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 Z 1l the To of outhold; that said Notices were mailed at the United States Post Office at ,that said Notices were mailed to each of said persons by (certified) (registered)mail. Prc� Sworn to before me this Day of 20 Notary Public YN-.970- /1-137 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS i Service •URTIVIED MAIL 11CUIPToS Address: ve. • . Co ..• . .-. r. Ll o ��v5 (°1 ��Y, 113�7 "' TFee g DIY G Dn- 117Postage $fied Fee f2.10 G14510 Postmark r-� ipt Fee $O.�d Here M (Endquired)0Resery Fee :a.as(Endoquired)O Tot $Fees $ $2.67 01/11/2002 M N ase Print /earl (to be completed by mailer) Qn_ y /S -------------- ------- -------999 See Reverse for instructions Ceil &wc, residing at � !/� p ,being duly sworn, dep es and says that o the day of �at�. ,20jQZ 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 assessmentUIP0 the To of Southold;that said Notices were mailed at the United States Post Office at n that said Notices were mailed to each of said persons by (certified) (registered)m� il.. Sworn to b ore me this j Day of 20 a2 Notary Public YN-a7o-A/3 7 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS U.S. Postal Service CERTIFIED MAIL—RECEIPT Address: 1�e-0 7(Domestic Mail Only;No insurance �01 j 5 l�l• �`G'C�a .Lr) Coverage . . . . l , Ill Il 31�� 0 co Artic Sent To: r" IIEW 1 o- ir Postage $ 0.5 r7 Certified Fee $2.10 014S 10 Postmark r-1 Return Receipt Fee $0.00 Here ru (Endorsement Required) M Restricted Delivery Fee C3 (Endorsement Required) $0.00 p Total Postage&Fees $ $2.67 01/11/2002 m Nam&Mwse Print Cle y)9b be completed by mailer) - ---------------------------------- Er _a -- PS Form 3800,July 1999 ✓ _ _-Reverse— --Instructions residing at /iZs / 6124, being duly sworn, depo es and says that l o the � ll _day of jy, ,20_W..,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 r 11 o the To of S uthold; that said Notices were mailed at the United States Post Office at that said Notices were mailed to each of said persons by (Clified) (registered) il. ev,cJ 1��cE�nf oxfee I � Sworn to before me this �l Day of IW�) ,20__ Notary Public 8 1�a70-11-137 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS PostalAddress: CERTIFIED MAIL P4ECEIPT (Domestic Mail.Only;No Insurance coverage Provided) Socllol� �f. l f Q7/ CO r rr. . F— Postage $ -0 $2.10 0145 � Certified Fee 10 Postmark r-q Return Receipt Fee $0.00 Here rU (Endorsement Required) 0 Restricted Delivery Fee $0.00 C3 (Endorsement Required) r3 Total Postage&Fees $2.67 01/11/2002 R9 Na a Print/Cleddy) (bbee completed by mailer) r S et NeA o. 0Box/Vo. Er Cp ,Slate ZIP l/? , a�3o ,f o residing at �iZ� V/ L y ,being duly sworn, dep` es and says that onthe _day o �JQ/Je ,20 Z deponent mailed a true copy of the Notice set forth.in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names;that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment ll f the T wn of Southold;that said Notices were mailed at the United States Post Office at V, that said Notices were mailed to each of said persons by (certified) (registered)mail. ��' 4ejtl RrOPIC4 Psl ice Sworn to before me this Day of�o ,20c_ W W Notary Public �270- 11-137 U . • . APPLICANT TRANSACTIONAL DISCLOSURE FORM The Town of SoAhold ' s Code of tthic•s ofohibibs conflicts of nterest on the part of town officers and emplo Bees . The ur ose of this form is to Rrovide information which can alert the town of possible conflicts of Enberest and allow it to bake, whatever action is necessary to avoid same . YOUR NAMES Last namer--tirst name , m dd•le n t al , unless you are applying in the name or someone else or other entity, such as a company if so, indicate the other person ' s or company ' s name. ) NATURE OIL APPLICATION: (Check all that apply. ) Tax grievance Variance Change of zone App Wal of plat Exefption from plat or official map Other 11AA611,(if "other► " name theeactivity . ) ' Do you personally (or through your cbmpahy$ "pods"`, 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 OTES, ", complete the balance ' mf thiij 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) 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 apousei sibling , parent , or child is (check all that apply) s 11) the owner of greater than 596 of the shares of the corporate stock of the applicant (when the applicant is a cbrporation) t b) the legal or bbneficial owner of any interest in a noncorporate 'entity (when the applicant is not a corporation) l C) an officer, director, pa•rtnnr , or employee. of the applicanbt or D) the aptual applicant . 4 DESCRIPTION OP RELATIONSHIP IL su•btnittedl thig '' ;,d d� y... .Y u 'Print n e . � '., '- .;f. .,;,,;,:• .' . 4: �'r'11 ,�.,!;'.•.:',!:1,'.r.�t � SVr: . •.,.'.•i.,Fy:•