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HomeMy WebLinkAboutTR-6040 ..i x James F. King, President -``'�'QF so yo Town Hall Jill M.Doherty,Vice-President ,`O l0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen John Holzapfel �� Telephone(631) 765-1892 I�COU '� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Building.Dept. FROM: Board of Trustees DATE: March 15, 2006 RE: ANTHONY & NICOLE SPIRIDAKIS 8915 SOUNDVIEW AVE., SOUTHOLD SCTM#59-6-27.3 With regard to the above-referenced property, an inspection was made and it was determined that the single-family dwelling and garage were constructed in compliance with Wetland Permit#6040, as issued on December 20, 2004. If you have any questions, please do not hesitate to contact us. Albert J.Krupski, President Town Hall James King,Vice-President _ �OSVfI'0(�C 53095 Route 25 Artie Foster �0 �G R.O.Box 1179 Ken Poliwoda o y� Southold, New York 11971-0959 Peggy A. Dickerson y Z Telephone(631) 765-1892 O Fax(631) 765-1366 col � Sao BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE ,/ Pre-construction, hay bale line 1st day of construction % constructed V +� Project complete, compliance inspection. 3I s1 b6 b r SURVEY OF PROPERTY N 51 TUNE: SOUTHOLD TOWN: SOUTHOLD SUFFOLK COUNTY, NY W - E SURVEYED 10-13-2004 AMENDED 12-01-2004, 12-14-2004 S 02-14-2005, 03-11-2005, 03-14-2005, 05-16-2005 FINAL SURVEY 02-07-2006, 02-Oq-2006, 02-23-2006 SUFFOLK COUNTY TAX # 1000 - 59 - 6 - 2-1.5 - SUFFOLK COUNTY DEPT. OF r' .`•, HEALTH SERVICES REF. RIO - 04 - Olbb ~'� « " :1 CmTE=T0. _.r. AnthonySpasiaakls M�R, 2�"j r� ,pRNi��c�.]o.�.,l..+rep+�.�^S.+p�iryilcHppa7>�ds.���.q���(�1o}�•�}�y}� �� ank Lond Nov, or Formerly of: WELL. -� George L. Penny IV Dwelling L 9C1 qh "S8-6 2f-2-&`T4, l 253.10' o Y � � Y YY Y \`\\M � .•p•�� Y ' ON ! I ' -Y _ •,�� �__ -_-------------------------- ---------- A PA7} �� -�� \ e�,��• Fta age �16';�B�P �\ v� 9FF' tof,� 6a�2�' 3 ap 026 zs,� l7 Noy \ — ` 9 o Z% ✓' ` \ t �o � �t lit — a 0 PA Ego V 27, Y Y Sg 4 S6 �� Z Y Y p I Y Y H 0 00 Y L 0 Crpin i - \ �A ull�J Y i' PIP. a0 W Y r' =W Y h 9) Y 0 Cq Y'63 0 O'/fvj00 <q,,a •96-, /v o NOTES: C/ewe `j Cor er m p PIPE FOUND VgC���QrneW op: ELEVATIONS REFERENCE NGVD '29 DATUM - PROPERTY ZONE R 40 J t •,.v �i '.J. �,.; ,\ !u`- ^., l-12ti1. ,tA��' •�t n`- /"J�' vlolr>lini 1..:cl✓rr'1:!01. ,1 aI llrc FLAGS SHOWN THUS I DELINEATE EDGE OF FRESHWATER kw r'orP'A nik -Vn., WETLANDS AS MARKED BY BOB FOX DATED MARCH 10 2005 f q ( E•� el<rrq,.:r,sr I:Inll Le> r.I,Icr.:J I�,Lx�vrllr,Ir ue • '� i-, '.�+i.' 'Gcr111L a14wr<.LviiuNOA F+w oar sIr,61y Irrd ILis The NYS Freshwater Wetland Boundary is equal to R. Fox's line as shown on ;� _ i '\; ,�'"��� :w•=y w`:I>r t>• ,I:,�<�<4..:., ltlr ll.- t t- I.m:I+•.r.ror1:stm.:Asaxh,l l,..<.r rr.,l4•..L,r.,l the survey preppared by John Ehlers last revised 3/14/05 as determined by ,` �t•. _� m<I'_.rrm:y ,.,f,tl rur tll nl Vnr.•J n,ll rmi di4, R. Marsh 4/6/05. r A n hls b 1.11 In 11.:Ill lc nrq,vu,.,ov- .n \)` /�� ' lol.x�or n,n 1 c rcrg'vidihpon 11 ulcA Lv con c tlu:Icr ir��n irvl 11 tlor Gcr lil ica Drywell locations as per builder - _ ;.,t tills- n.,l lr<..<IcrwwI rrnanlor;l u.rwuon, AREA = 73,811 S.F. or I.ba45 ACRES COI[— N Co -EH ERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 RIVERHEAD,N.Y. 11901 GRAPHIG SCALE 1"- 50' 369-8288 Fax 369-8287 REF.\\Compagserver\pros\03\03-249-LOT-27-3FINAL.pro ri9noae .w \ ga�osaaa�or_n_�Iw`L 5URVEY OF f�ROFERTY FF EL•16.5• 51 TUATE: 5OUTHOLD ss....... GCA1rvc CAST—CAST— N TO G6AGE GNAGE EL•la.] TOM 5OU(/T�-fOLD EL•14.6 EL."-I INY•13.3 INUSE INV•13.5 �OL7Y\■ � V V/�UN. 1T- 1nY.12., iNY.,2.6 5U w E 3-6'GIA I a•Eff GEPin faaa GALLGH LEACHING POOLS SEPTIC TAM 5URVEYED 10-15-2004 AMENDED 12-0I-2004, 12-14-2004 EL-5.5 EL•6.3 02-14-2005 s 5UFFOLK COUNTY TAX # GPWtAYATNE6 EL•A.3 1000 - 5q - 6 - 21.5 CERTEFM TO: 5EPTIG DESIGN BY MICHAEL MAPE5 P.E. AnthonySpidldakis dalds E dymac Bank E C Chicago Rifle Insurance Company D 17 2005 Southold Town Board of Trustees , Land Now or Formerly of, WELL George L. Penny IV Dwelling L 9c, 9,y \ edge of drlvewo S86026'2811E 253.10' I \ Vol, — / / / — — / / / hole �vov- ppot- s AA co ' — s y P yeP \ c \ �•'��•,. \ \ ��j\s \ \ ;sue _�- 1 I � G �► "`�,\ \\ moo\ \\ ,�_ / /, - � _;-.�= ; - � �° vo TE5T HOLE M DONALD S9�6 ,,�� 6EOSGENGE Q l ill I I I II-10-2003 eFv.lS Qf� Oo on' DARK BRIM! ILAf ':i i ' ' i dP e a Long ra K PALE BROYAI 51LT / /COAMSM BROM FINE TO / AGRIM > 3,/ / o.T WATERS o 5W WATER IN BR"1 ' To GOARSE 5AW ¢, D <4 l00 Z ;0 nq *' ® C/e N oW o —3 Q ® ;a meryE J Form G (�E -rt ® VqC�ChQr,-) � ® NT p �"P 1 r � Y A J - a i �� I 6A.. 1h�oullnrlxetl oltorouon ar—ilon to suvey �^ f�(�rt43^' moP beo Yiy o o lob seal I No b I'­— ' —1tdbfdy —ton State 2.01NOTES: _ Non Yok Edatlon Lai.e ' �y-1� -only 10011 From the orl MI It thl,survey p RIP OUND 1 1r. l � '� y anyetl of"ISM11 be=X, to be yolk we r ,k.t�S t copbs' ,t� s 'GertlFlcatlorn Irdlwted hereon slgnliy that Ihls EDGE OF WETLANDS BY SURVEYQ�t +' ry y Ps�a ey,-rPraP-,ad"aLwrdanae"IHdoe.- I tYg Gods oP Practice Pa Lad Sof PlI adopted 1�' y f Q aJ the Nen Yak State As WII,bn of Professlo my Lofd Surveyors. Sold certlflwtlona etnll run only ELEVATIONS REFERENCE NGVD ' ATUM �l" 6 o W on his onh J'[a t n lltbh com.md reP-n 44✓'1" tal ogency ono brd4ig lrenmtlan rated he aa.and .�/yam to the ascl9,eee oP the IendlnJ oodl on,eertnlw- �'�%�,(t\(�{'�o_'� elan re ret tronsPor�lo eo oddNlonol 1nue�tbr�e PROPERTY ZONE R 40 JOHN C. EHLERS LAND SURVEYOR AREA = 15,511 5.F. or I15g45 AGRES 6 EAST MAIN STREET N.Y.S.LIC.N0.50202 GRAPHIG 5GALE 1"= 50' RIVERHEAD,N.Y. 11901 369-8288 Fax 369-8287 REF.\\Hp server\d\PROS\03-249—LOT_27-3.pro ]A4lIPa9 9 b3-aK La James F. King, President ��QF SOUr�o Town Hall Jill M. Doherty,Vice-President ,`O l0 53095 Route 25 P.O. Box 1179 Peggy A. Dickerson Southold,New York 11971-0959 Dave Bergen G John Holzapfel �� �Q Telephone(631)765-1892 IyCOU '� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Building.Dept. FROM: Board of Trustees DATE: March 15, 2006 RE: ANTHONY & NICOLE SPIRIDAKIS 8915 SOUNDVIEW AVE., SOUTHOLD SCTM#59-6-27.3 With regard to the above-referenced property, an inspection was made and it was determined that the single-family dwelling and garage were constructed in compliance with Wetland Permit #6040, as issued on December 20, 2004. If you have any questions, please do not hesitate to contact us. �iAsdo Board Of Southold Town Trustees �. �• SOUTHOLD, NEW YORK `. PERMIT NO. ... ..... ...... ........ DATE: Dec.-20. ...200.4 1 ISSUED TO .ANTHONY...A 4D HICOJ:�.... P ..I1;��1KZS............................................ •a . K Pursuant to the provisions of Chapter 615 of the Laws of the State of New York, 1.893; and Chapter 404 of the Laws of the State of New York 1952; and the Southold Tovm Ordinance en- ' titled-."REGULATING--NDJHE---P-LACING.-OF.OBST-RUCT--9S ` IN AND ON TOWN WATERS AND PUBLIC LANDS and the Y L OF SAND GRAVEL•OR OTHER MATERIALS:..FOM REMOA , R 's LANDS UNDER TOWN-WATERS;•..-'. and in accordance with 'the Resolution of The Board adopted at a meeting held on .-De.... 2Qo4.:._, and in consideration of the sum of $m.,.qQ........... paid by Anthonynd Nicole S t ..n ........................ .P.�.x.isla}cis..-..................-.... � of .....Southold........................ ................................ N. Y. and. subject to the Terms and Conditions listed on the reverse side hereof, of outhold Town Trustees authorizes and permits the following: Wetlan Permit to construct a single-family dwelling with a t garage, sanitary system and pool with the• conditions of gutters and drywells to contain all roof runoff, a' 50'non-disturbance f buffer and a dry well for the pool, and all as depicted on the r planall'in 'accordance with the detailed specifications as presented in the originating apprcatiomsurveyed. by John Ehlers last dated ' 2/14/05 IN. The said Board of Trustees lwre- WITNESS WHEREOF, r by causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board .as of this date.. O • �,/ (� �y,, Q Artie Foster TW Permittee Anthony and Nicole Spiridakis tGsiditig at Southold s N. Y., as. Vur of the consideration for the issuance of the,Permit does understand sand presage to the fol- lowing: 1. What the said ]Board of Trustees and the Town of Southold are released from any and all damages, or damn for damages, of acts arising directly or&&reedy as a result of any open- - _ tion_.. ,erfonasod....purniaat �chis. perinit,._twt1.. �. ___.. _ -iu. s-.or-:h«.. ewe, defend any and all such suitclaidated by dtlyd parties,.and the aid Permittee assumes W fiabillty with respect thereto, to-thcplete'exclusion of the Board of Trustees of the Town of Southold. 2. That this Iiit Is*valid for a &dod of -24 -mos. which.is ddaideitd to be the estimated time-required to complete the work involved, fiut-should drdmmtaacts warrant, rapat for an oiension 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 sad 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 resoludon of the said Board. 5. That there will be no unreasonable interference with navigatim as a result of the wodc herein authorized. G. That there shall be no interference with the right of the public to pass and repass along the beach between Ugh and low water tuarks. 7. That if future operations of the Town of Southold require th&&removal and/or Alt'eratlon$ in the location of.the work them and odwd, or 14 in the opiaioa of-the.Board of Trustees, the. work-shall cause unreasonable obstruction to free navigation, the said Permittee will be eequirod, apoa-due notice, to remove or alter this wodc or project herein stated without expenses to the Town` . of Southold. 8. That the said Board will be notified by the Permittee of the of the work wth- odzed. 9. That the 'Permittee will obtain all other permits and comeats•that way be required sap- plemeatal to this permit which maybe subject to revoke upon fail= to Obtain,soma - .y �S�FF01.t Albert J. Krupski,President 0�. QG Town Hall James King,Vice-President �� 'yam 53095 Route 25 Artie Foster y = P.O.Box 1179 Ken Poliwoda %�sy • Southold,New York 11971-0959 Peggy A. Dickerson �Q a� Telephone(631) 765-1892 1 `1► Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 20, 2004 Building Inspection Services 606 Fox Hill Drive, Baiting Hollow, New York 11933 RE: ANTHONY AND NICOLE SPIRIDAKIS 8915 SOUNDVIEW AVE, SOUTHOLD SCTM# 59-6-27.003 Dear Mr. Scholz: The Board of Town Trustees took the following action during its regular meeting held on Monday December 20, 2004 regarding the above matter: WHEREAS Building Inspection Services as agent for ANTHONY AND NICOLE SPIRIDAKIS applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated November 5, 2004, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on December 20, 2004 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 97 of the Southold Town Code, r 2 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, RESOLVED, that the Board of Trustees approve the application of ANTHONY AND NICOLE SPIRIDAKIS to construct a single-family dwelling with a garage, sanitary system and pool with the conditions of gutters and drywells to contain all roof runoff, a 50' non-disturbance.buffer, a hay bale line at the 50' line from the pond and a dry well for the pool, and all as depicted on the plan surveyed by John Ehlers and last dated 2/14/0; Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) This is not a determination from any other agency. Fees: $50.00 Final Inspection Very truly yours, Albert J. Krupski, Jr. President, Board of Trustees AJ K/hct Albert J. Krupski,President SUFFot�0�� CD Town Hall James King,Vice-President I�'Z` Gym 53095 Route 25 Artie Foster p P.O.Box 1179 Ken Poliwoda `W r Southold,New York 11971-0959 Peggy A. Dickerson • `F Telephone(631) 765-1892. Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ro IC�Gi�� SC � o �Z p21 �► `Jn� naa Nicoj Srpi� i {�ikr Please be advised that your application dated NOV ' St aU0`� has been reviewed by this Board at the regular meeting of De t. a 01 200 y and the following action was taken: Application Approved (see below) L_)Application Denied (see below) �)Application Tabled (see below) If your application is approved as noted above, a permit fee is now due. Make check or money order payable to the Southold Town Trustees. The fee is computed below according to the schedule of rates as set forth in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: S`houn�)- Jr'we(( - ( ool� Se ( of 100' m, uue-t('Ar, 6'4y "(e L4+Ra 6r1k c,ry 'X(h ar,7 house �C7 h�i� bide � (nSf2C-4,0 t 5a fiiV►�( I tj CC410VA TOTAL FEES DUE: $ 1 b d . b ° "Ij r SIGNED: A4..-O t2_ PRESIDENT, BOARD OF TRUSTEES Albert J. Krupsl E)sident Town Hall James King,Vice-President �OS�FF�(�'C 53095 Route 25 Artie Foster �� �G P.O.Box 1179 Ken Poliwoda = 1J� Southold,New York 11971-0959 Peggy A. Dickerson y Telephone (631) 765-1892 O Fax(631) 765=1366 BOARD OF TOWN TRUSTEES .. TOWN OF SOUTHOLD YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE WORK, TO MAKE AN APPOINTMENT FOR A PRE-CONSTRUCTION INSPECTION. FAILURE TO DO SO SHALL BE CONSIDERED A VIOLATION AND POSSIBLE REVOCATION OF THE PERMIT. INSPECTION SCHEDULE Pre-construction, hay bale line 1st day of construction Y2 constructed Project complete, compliance inspection.. RESOLUTION RESOLVED that the Board of Trustees of the Town of Southold hereby finds that the application of ANTHONY AND NICOLE SPIRIDAKIS more fully described in the public hearing item #13 of the Trustee agenda dated Monday December 20, 2004, is classified as a Type II Action pursuant to SEQRA Rules and Regulations, and is not subject to review under SEQRA. Telephone p Town Hall (631)765-1892 4 53095 Route 25 O .1C P.O.Box 1179 4 �� Southold,New York 11971-0959 . col � �a CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tues., December 7, 2004, the following recommendation was made: Moved by Jack McGreevy, seconded by Nicholas Dickerson, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of ANTHONY & NICOLE SPIRIDAKIS to construct a single-family dwelling with a garage. Located: 8915 Soundview Ave.; Southold. SCTM#59-6-27.3 The CAC recommends Approval to construct a single-family dwelling with the condition hay bales are placed down before construction and a limit to the number of trees removed. Vote of Council: Ayes: All Motion Carried . e-xl-v J-JO-9 � ` 'b SfE YG H10N ?J /V1 �Oh s s CQ ro fW� ,� sr �,tr o 2 � �• i '-5'{ /r�d �� � L °h h � 4 3^ �^♦ ° °° vw sce x `Cr 9 afe� d dB2 d dF xT pe ^ a a O t>a 10I ° f4 °F q r a -Alt y 361° T—a SxU1MIL "TG °rN aka ° • - a CREA7 POND < o ^° `T ,�V osJbJ oo N "�ISM r�srovcF lµm a1 J r,? ° •E f Y°. 3 •6 •'. J f 9 a AmZd x G r� a ^r ^ ,� J .2S p S . �I p ^'f a a �aFO J� •P' " 10 y� we ax '�` •'^° � �1 p� a war ,d a' � �" ,B D ° S.a � •r^ �\, ST.IIw °� d� a LFr,G xsrG s� p'�r •> \ SOJN�✓ � � r 9d 3¢ d ♦ °�' M1 a�D L01(Ud O ap 4 Rr Y u�pAtU J0.F x 12 si NIFIfY OF SIiTOII. Lp11U T.61(U ° - d /, 1 alII6,g1 rJa19 Ip \\ 26x a ved a aY 2 Fee ] ° A ISM �j \ 1151(cl x81 y Q °F F •V \ FW fC.16 6FI(U 1 y� J 1 —m5r---2F-- Fm rls.ws¢ 9 Iso•, P p P SFF YL N0.0a gF S�lp•0Fy SEG N6069-Ol-OOSI O•� L K © K ® '°'" SOUTHOLD sEcrwN No �_- — NOTE NCOUNTY OT SUFFOL a roPertY ax Service Agency RtLPr r...+m..f»nr 11 Albert J. Krupski,President o�0$UFF01,�co Town Hall James King,Vice-President �`Z` y 53095 Route 25 Artie Foster ti P.O. Box 1179 Ken Poliwoda coo Southold, New York 11971-0959 Peggy A. Dickerson • `F Telephone (631) 765-1892 �l �a Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application _�tland Permit Application --Major Minor _Waiver/Amendment/C an es -Received Application: - /Received Fee:$ mpleted Application 2 (� pA f� _Incomplete D l5 lUr U 15 _SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) NOV - 5 2004 --eAC Referral Sent: 7--bate of Inspection: Southold Town _Receipt of CAC Report: Board of Trustees _Lead Agency Determination: Technical Review: Public Hearing Held: II Resolution: Name of Applicant Anthony & Nicole Spiridakis Address 770 N. Bavview Rd Southold, New York 11971 Phone Number:( Suffolk County Tax Map Number: 1000 - 059 . 00-06 . 00-027 . 003 Property Location: 8915 Soundview Ave (west side) (provide LILCO Pole #, distance to cross streets, and location) `J AGENT: Building Inspection Services - Michael J. Scholz (If applicable) Address: 606 Fox Hill Dr. , Baiting Hollow, New York 11933 .___ __Phone: (516) 909-9145 Board of Trustees Application GENERAL DATA Land Area(in square feet): 23,277 Sq. ft. Area Zoning: R-40 Previous use of property: va r-a n t (R-4 0) Intended use ofproperty: Single family dwelling Prior permits/approvals for site improvements: Agency Date X No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes, provide explanation: Project Description (use attachments if necessary): Single familydwelling with garage Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Single ngle family dwelling Area of wetlands on lot: o square feet Percent coverage of lot: 0 % Closest distance between nearest existing structure and upland edge of wetlands: 0 feet Closest distance between nearest proposed structure and upland edge of wetlands: 50 feet Does the project involve excavation or filling? X No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? N/A cubic yards Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A Movement of existing soil for placement of _siICLI amily dwelling foundation 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): None Board of Trustees Application COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Single family dwelling Are wetlands present within 100 feet of the proposed activity? No X Yes Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? 0 (cubic yards) How much material will be filled? 0 (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) Movement of existing soil for placement of single family dwelling foundation 50 ' from "Great Pond" PROJECT ID NUMBER 617.20 SEAR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1-PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1.APPLICANT/SPONSOR 2.PROJECT NAME Anthony & Nicole Spiridakis 3.PROJECT LOCATION: Municipality Southold County 4.PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map 8915 Soundview Ave. (west side) west side of property abuts "Great Pond" 5.IS PROPOSED ACTION: ❑ New ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: Single family dwelling - Approx. 1750 Sq. ft. footprint 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres Approx. 2500 Sq. f t. &WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) aResidential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ❑Yes ❑No If yes, list agency name and permit / approval: 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ❑Yes ❑No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Dyes ❑No CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT To be completed-by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF. Yes ® No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes Q No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,if legible) C1. Existing air quality,surface or groundwater quality or quantity,noise levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly: No - Erosion control/containment will be used during constructio C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: No C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: No C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: No 5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: No C6. Longterm,short term,cumulative,or other effects not identified in C1-05? Explain briefly: No C7. Other im acts(including chan es in use of either quanti or a of energ ? Explain briefly: No D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA CEA? If es,ex lain briefl : Yes ®No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex lain: Yes ©No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and (f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actin WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Pnnt or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES,TOWN OF SOUTHOLD In the matter of applicant: Anthony & Nicole Spiridakis SCTM# 1000-059 .0-06 . 00-027 . 003 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to: Build single family dwelling 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: 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: Anthony & Nicole Spiridakis MAILING ADDRESS: 770 N. Bayview Rd. Southold, New York 11971 PHONE#: Enc: Copy of sketch or plan showing proposal for your convenience. PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: Anthony & Nicole Spiridakis 770 N. Bayview Rd. Southold, New York 11971 STATE OF NEW YORK COUNTY OF SUFFOLK Anthony Spiridakis ,residing at 770 N SaVvi Pw Ra _ Southold, N.Y. 11971 ,being duly sworn, deposes and says that on the day 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 roll of the Town of Southold; 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. Sworn to before me this Day of , 20 Notary Public Board of Trustees Application County of Suffolk State of New York Anthony Spiridakis 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 ,20 Notary Public Albert J.Krupski,President O�OSQFF�(�CD Town Hall James King,Vice-President �`t` G.y 53095 Route 25 Artie Foster p P.O.Box 1179 Ken Poliwoda Southold,New York 11971-0959 Peggy A.Dickerson • `F y � Telephone(631) 765-1892 Fax(631) 765-1366 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 I, �'�.cJ�o,�e�� d . �'e�y �,residing at (O 6 Td%A . 11 �r• A-1 1 fit.3 being duly sworn, depose and say: That on the jo day of b< , 20011 personally posted the property known as ��r►cam-1c:� CSc.�w�''� SS �. � -a�•do3 � by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held 4YWDh-r ,o Q C, (ol oU join , Dated: /02//o/a Al �fgnature)- Sworn to before me this ld' day of A,5- 200 Notary ublic KATHLEEN W COLE NOTARY PUBLIC,State of New York O/c'o .U942-1208140 Qualified in Suffolk County ff�� , Commission Expires February 28,d�L_. rd of Trustees Applicatic,. AUTHORIZATION (where the applicant is not the owner) I, Clement Charnews residing at 40635 County Rd. .48 (print owner of property) (mailing address) Southold, New York 11971 do hereby authorize Buildong Inspection (Agent) Services - Michael J. Scholz to apply for permit(s) from the Southold Board of Town Trustees on my behalf. 74 (Owner' s signature) 8 APPLICANT/AGENT/REPRESENTATIVE 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. YOURNAME: Anthony & Nicole Spiridakis Represented by Building Inspection (Last name,first name,.qiiddle initial,unless you are applying in the name of Services (Michael J. someone else or other entity,such as a company.If so,indicate the other Sho 1 Z) 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.) 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 X 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); •'r•. 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 None Submitted this day of 200_ Signature Print Name Form TS 1