Loading...
HomeMy WebLinkAboutTR-1253 i • OSOFFO(��, Albert J. Krupski,President ��. Q Town Hall James King,Vice-President =� Gy� 53095 Route 25 Artie Foster P.O. Box 1179 Ken Poliwoda x Southold, New York 11971-0959 Peggy A. Dickerson 'y.�rQl �aQt Telephone (6316 31) 92 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 21, 2004 Mr. Jim Neumann 101 West End Ave., Apt. 21 E New York, NY 10023 RE: 750 EAST MILL RD., MATTITUCK SCTM#107-1-1 Dear Mr. Neumann: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 21, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#1253 to extend the fixed portion of the dock 20' and install four new pilings, re- sink pilings for floating dock 6'X 20' and a 6'X 16' ramp with two pilings, and as depicted on the plan dated March 18, 2004. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, - .[ L Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims Albert J.Krupski,President ��. QG Town Hall James King,Vice-President o� y< 53095 Route 25 Artie Foster P.O.Box 1179 ti = Southold,New York 11971-0959 Ken Poliwoda _ • Peggy A.Dickerson y �� Telephone (631) 765-1892 ��.( `�►a Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD April 21, 2004 Mr. Jim Neumann 101 West End Ave., Apt. 21 E New York, NY 10023 RE: 750 EAST MILL RD., MATTITUCK SCTM#107-1-1 Dear Mr. Neumann: The following action was taken by the Southold Town Board of Trustees at their Regular Meeting held on Wednesday, April 21, 2004: RESOLVED, that the Southold Town Board of Trustees APPROVE the Amendment to Permit#1253 to extend the fixed portion of the dock 20' and install four new pilings, re= sink pilings for floating dock 6'X 20' and a 6'X 16' ramp with two pilings, and as depicted on the plan dated March 18, 2004. This is not a determination from any other agency. If you have any questions, please call our office at (631) 765-1892. Sincerely, P ° Albert J. Krupski, Jr. President, Board of Trustees AJK:Ims I I • i i NEE • I A, ID K ` o� o� �J I I � 0 O I LO 3 0 N O N ' N•1 00 U) 1 ' Eststes 1 ottitu ck Co e N e g2�3 subdivlsio l County Fil - -N suff o _ N Lots gg6.82 c :O \ LO CO. tP M ' pp n CA 5 N 1� o ° z5 T \ —0\ A> \ 1 1-0sue 0oo cfl > c9 \ 0 QP do O • LOT T c vvvvvv r') -I'83S z o \ NO v 'IN" �jf D �c' O Or; `oF`� m 99.55' ' — — a � N .02 — — \ � N OJ3�' FRAME Z / ` BLDG. w / N (J� 1 \ 1 I O� W I A z _�i W Z z / _� S�b0 O" J _ I. 8 �•CI �� lljj 3N. O (LZ) / / )e•�O-r 96 OOO ,IV L J y _ I�L'SYCI O� Iv FLO/1-yo 0! S/ M 4Q I �' IL�'68� N — .ze Ir �. 3 I.IZ S ZZl �� S O 1"��)��e 30^"o m I 00� 3ovaois 3 I,0 N �,� �.. Sl N I o bto I ar 4 J 3wt♦a3 3, -�`n �,,�ZL `�BZL 1p9ol i oN dp o G ry 'ems •6�+ " £;� L � '� O I T o0 1�-- E Y �3 N 3 0 �8 't'/)dyy � � co T o o L. h°j 3 ��'�Q 00 w I �N w 0 N �� _ �tri �N ` Z O N G � G L. cn :f LO „ N '� O O . O N O 0 O ;r ,l � s 3 E _ 3 0 L0� .. __- - o o v- v- 0 a r1� 116f%gexo IZ L'68 G c CC K L,a G►�Y t Z N 3 .9Z,6Z.10 - - \ G ci ' I M�-f-Tliij CK CREEK \ � C E 0 V E i I MAR 2 6 2004 Southold Town Board of Trustees 1 I I i CP Cn c z c .1"., C � L l 1 m to O SfJffO(�f' Albert J. Krupski,President �� C'�G Town Hall James King,Vice-President 53095 Route 25 1 P.O.Box 1179 Artie Foster y x Southold,New York 11971-0959 Ken Poliwoda Peggy A.Dickerson .f� �� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: Jim Re U-mo-m Please be advised that your application dated 3 l0 0 has been reviewed by this Board at the regular meeting of �A� S(t and the following action was taken: (_:!!!:� )Application Approved (see below) Application Denied (see below) L_) 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: CASH �� 042RECEIPT 037k `Da4e � s Ul CM WQr ✓�'V / / - s Yam/ ✓ I, Received From Y ✓ f' ' co p ; Address' / ., r rat r ✓ / Cr- C r / ✓i /✓£ ✓ ✓ ✓/ / r r/✓ �pDOIIarS/� / / ✓// /✓ /` /'// ✓ /'�✓ v //r 3 i/✓ 0 LL 10cc 0 cFOC / r. /, / r ✓/'r` %✓fir r /r ✓i f✓ LL Z CL C. /r r ✓✓ r /� r ✓ HO PAID 0 ACCOUNT 0 AMT'OF / .CASH r T' Ufa/✓5 r' ✓/ /✓,/ /'✓/ r / cc o ✓ s, / / ., ;, �� /r,1/ s� ,/ / �� y' Lo O AMT�PAID �/ , CHECK ✓ / ,. ;, ,, BALANCE / MDNEY ORDER❑ / ✓ Y -.✓, ,r'/.; :,/:.." 'CREDIT CARD❑ r/ " ' o��S�FfOL��oG y� Town Hall Telephone y Z 53095 Route 25 (631)765-1892 P.O.Box 1179 oy �� Southold,New York 11971-0959 col � Sao CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Tuesday, April 13, 2004, the following recommendation was made: Moved by Don Wilder, seconded by William Cook, it was RESOLVED to recommend to the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the application of JIM NEUMANN to Amend Permit#1253 to extend the fixed portion of the dock 20' and install four new pilings, re-sink pilings for floating .dock 6'X 20' and a 6'X 16' ramp with two pilings. Located: 750 East Mill Rd., Mattituck. SCTM#107-1-1 The CAC recommends Approval of the application with the Condition the ramp is 4'X 16' rather than 6'X 16'. Vote of Council: Ayes: All Motion Carried -PGWG w9 Environment East, Inc. 2885 Indian Neck Lane P.O. Box 197 Peconic,New York 11958-0197 631-734-7474 -- Fax: 631-734-5812 April 5, 2004 APR 7 2004 Southold Town Trustees P.O. Box 1179 Southold Town Southold NY 11971 Board of Trustees Dear Board Members, I would like to add this letter to the permit filed by the Neumans, Kathleen, Jim, and Michael for the extension to their current dock on Mattituck Inlet on the south side of East Mill Road, Mattituck. I agree with their need to extend-the dock and that they are right in the middle of the East Mill Road run off problem. This run off will contipue to silt in the inlet until the farms to the North practice contour farming of a sump in. I arri responding as t wner of three properties on the north side of Mill Road. Sincerely, Peter R. Stoutenburgh I y;0 _ 3 19 FF7 tU FU wuliu Y11 W IN tl ttl I rl q qi M �r . p , _ h _ I u'�%3:a- �� >�fry�.-+.sx�s-�"'¢'S.-• Imo."�`"'���„��t�-.'+".-.+�.,�'\-"� � n..,''�""o...�•�s.�`�•Y.��„ 'T^ r1is f r ati- .Ff lrr f r A: � 2F,_ _ { y IN , r ss1�A7^� •( 7}S j,; j_ �,� y.ty .y4.w.v�?%z"Y"�' -r• I s letr t4,r t V �>�,` •7r=^atYh Ir _: n . ut g - Igo"Hf■JJ.�` � y,`Y> .ii l�. __1' ��1 �J1� I I 7 i���� 1.'��i� 11�111•���I lil'� ..� �1�� �, _� ¢- • .M.i sS`�'" .,. �_.. Eel __- _- +r.`. _ - 1. r _ _ L > _ _• .. „^r V T t', X7a C r.:l tl�♦...:WS 0�� -Y x� `rt�f� � 't r'�`' � •T ; '� of fl��' I�,r1 �:�! �1 7i� o��k���i • 4 l 4 f • .�.-t .. J t s '} r ?�s �r>a��'ke4a*1r Y��a` t , c ,. .. - ... }s r lEr r'^'T s S`1`.4ra;�aV•f - r aY TT i 03/08/04 MON 14:32 FAX 6317 166 Southold Town Accow B 003 Baia •O .;. outhbt �'o Kruk.ces': D400xa n SoUT'Ip[p,t4M YC�RK _ 1253 P�itMli NIO DA :iOct. . .- 3a, 1989.i. TV Fdrul is . � • .. ` �''•�`••;��`y. ��• � ��� _• Purn+ae�7p ► �c P ' et".��5^of t}re favrs �F ,Y r - #h �t e n w r Sav tf tie Layr�of thg (': eW��faA-:}."Wa.6 46 . d'�f 4ed�e�e�ee td}et�•'�E�UU41iI�J�ID:` I,:�iGY ..rC?lY`aBSTfEU�.:TI.�MS •I; s •, �� fS.reWp, 1tNDS end..fhe a.C% `V �i�-Yvi ar.R�l1LSi FRO - C11kILfERW1 ?I?�lr�1t ;,q•ati irk'acice wFifh;fGa } '+ lOif 0 ' to BQatd es'dptaid at A! g: io onQct M30LL a d .. •...•:••'« y r E�7C � :SY11Y . i.���'� so� fCro ix er wF ' •"'!' •' .. �tix FbrJ[ Ha�Cne �oa'SErabt`' fi .'�'iy""`� - sorrthoid 1!` ard;#u1�eCi to;the Tereus dhd �ogd�or<s ltzted o:t'16e srde hereof curo}d 1'oWrr Trtsfeea.edhorar1 e'. Abe focw(n To(rej�aq,Ia;o;r3girlal dock"to ada;F�ot�ng dbcie``01�' p=�P�s loc&ted oa 1��.BoeS,`I4a�Cif.YSCk, 76!a20� dock eR pe aceordanee witty �ha detaded speaT�ca f 3�oas as p'asantee! m 7 1•,:. the origmafaig�P�i•(on.: - - !M tiNfTNESS-VlfiiFREOF,The sa(d Boaed of Tivsrees hsrs- by caasa�,ds Corporate 5e�`iro}sea and these pieser>ts to ' tya' t(bser. by a mra�on the' rd r r ea crF: , afia v �rlf MM .�F MI B. rard Of Sv:uhof d 1'ouin 7rusee •SOUTHOLD,NEW YO'&K . ' - 'N1oor5.ng".wit•'PTo.' _ _ Hate: . 2� Certify that-the-•-work as ae�t ozi'zed this permit;has been co,¢pleted and is frtow re.-I for your .inspection. Alsor the number required on•this project is'Cle_arty visible. . further un3esstatsd'.this pexmtt is xot valid until this tear oft sl�eat is retuxned to tt1e Ttstee Office.. .: 03/08/04.:MON 14:31 FAX. 6317 �66 Southold:Town`Accow' 8 0 001 TOWN OF SOUT HOLb BOARD Q1;50UTk'61:II.;r6' TRUSTEES ' .. 3'Cl[1•TH01�:'�A1i:g11.'It•EiRyC 'F1tt14rsds P,c?r} sAftf 304�y.....•.,stlas bean granny!the;tT4�wnrustes gacoitdipg to erplitahto�41114 3 .,.. .:�.,f b�tAypltt�nt .. ;,;,o.. K. t .�e� _ ore .Uc3 i9.�5 :Fc H�ap'aF the ti" 11 e.kept at1 file iKr th9•�`><tts e O 1ef'ihe.sppfti dv Off nUFilh'e{ Permii�rsn{sd Lo datfie#ollowlrig work �TV. o rebuild aog4 � p8:dnrl�. Locatiqu ;propeCty'on wh�cfi vuork to tia done w°a.:.Seatas Qp'le..n. �i-- - o8da L+attitliCk. . .. Creek,'tigy or7iarbnl frgrJtrng Proptny Cvcic eels ti, LY •..... $Ile Of*9 I.: . .Z6 r..s...� :a A' ......«... .... Ih'rdth 20* ...:, Height Above High Water .. ;f .. ... ... 'Depth Below Logy Water.„ 8 to 10 Yards is be l=xcavaoed �rA, ,,....... ' *ands to be Filled N/6 Manner,"wfiich material rs to be removed.or depnerted .. ..,.. t­mz. -._:` Intended use of•Property ..,.,..8eaideatia� „_ .........� ...:,, • - •MMN.....:.••r...1�.....www.........- ------. .........w.u..••ur•• .. .wu...M•-r_=•i ww..r..r•r••. - Conditions if any......r..:,,..:....w,:......:... M......_.........:.......... .....:...N....:..:.....:r...:_..:.,....._......: ........ .. ._ ....r... ....................::o_ ......:........................:..: xpira Qn bate UCCober 90`_1486 ; work 1.9 n6t,&R4�eIIS.e� ItX..&nisi.slake_.................... ....Le l7R.-,. 9x�sk.l�BRrs_xhe.. Number of lnapectroiis.Requlr 2 tees Are to not cp�p3atipn_.a> ..... the work. Inspacrion Fees. �,�.. . ... ... ••Ciability.Policies in the Amount of .....—'-�..............e...,.;••. .... -------- ........................... The validity of 3his parrriii°is or may-ha subject to the approval•of other governmental or municipal authorities. T[tie Town:accepts no rc possibility in-applyi q for:or obtairdrig such approval. in the. 'event that such approval Is riecessary,'the-holder of this permit shall.not commence operations here- under until such approval.has heen obtained in writing.The failure to obtain such other approval whon requited shall subject this'permit to immediate revocation by the_ Tra�Eees•upon receipt by.the ' Trustees• of•:written hatice from such other goverrrmen al or municipal authorities of its refusal or AN 1� disapproval_ 03/08/04 MON'14:32 FAX 6317' 166 Southold Town Accow a 002. The:sppiirarrt don by the acceptance of this peri�tit,assume ell responsibility•for Oppraiion�under: ----•— I ' taken puniriant to this permit;,arid shell Y2ke all plequtions f g the'pre-ve'rntion of injuries to persons end property resulting from such operations,By si3ch acceptance,the appliMi i also agrees to indemni- fy and gave harmless the Town,and its.officals,a$eitts.and_employees from any artd all aaims arising from'opr3raeons under �1is peRnrt and',any'and all•,acts or ornb4ons of applicant, his agent;and .emp loyees. the epplIeant.and the mwher and gcclrparrts of the premises.upon VvFitch the operations adthdrized by. this permit ate being•eonducted;do,hy.the acceptance of WM permit;gnre:consmt to•the7own,and fu officers and erirpioyses to arroer.upon.the premises where such operations are being conducted to ntirke si,rtr ilupecuots as,the Toom�rnay deem necessaryto insun:thatsucltvpenrtivps are being con- ducted in•conforrP14 with this.pennit This-operation will.net wbstantialfy: A...'Advetsaly affeci the..%eCaands-bf the town. 8 Cause damage from?rosion,hrrbidity orslltation,. . C. Causa taltwaxer bitrusion3nW the fresh water msources of t[,e•tow: ;• A"eiy affect fishy shellfish or othler benafigixi nrariRe ofganisrns,aquatla wlldnfe and v�ege• ta>;on or the natural'habitat thereof:. E. 'tncredse the danger_gF.tiood and stgrm xrde damage.'. f Adversely affect nawgaticn on tidal waters or the tidal flow-of tiietidal,�raters of the'tmrv.'. G. Change the course of.any channel or the natural,rnwemek o{flow ofiarly vrartars.. t1: lNim&en or undermine the lateral support of other-lends in the vicirtity- 1 `OtheIWIse adversely affect the health,direly and'getmrai wetfarz'ort the people bf:t9te m*n. 4. . Signed :,¢`""�Jy� 3 ¢-af" e ? Pe=sr nt • _:;• .' Board of.§A3gho'fd }ipvari-7•l'us'fae'es' ' • Date .._.��I �G..,r l� - • COP4 March 18,2004 . N.Y.S.Department of Environmental Conservation SUNY;Bdlg. 40 Stony Brook,NY 11790 2356' Re: Amendment to Dock Permit#1-4738-01545/00001 Replacement of lost pilings and extension of fixed dock. Dear Sir/Madam: We wish to apply for an amendment to the above permit. The amendment is desired because of`the loss of depth at the floating dock and needed now as several pilings were dislodged over the winter of 2003-4. Enclosed are the required.copies of the sight and cross-view plans. It is only the fixed portion of the dock,which is to be new, extending , I a additional 20' providing fora 3' depth at apparent low water. The two floats and ramp yy�ill rerriame same. Tfe is my ftnformatiori: roperly.Location: 75 Est Mill Road,Mattituck NY 11952 Property Owners: Ja es;�Michael, &Kathleen Neumann tenants-in-common ) Winter7Mailing Address: Jim Neumann 101 West End Avenue, Apt: 21E New York;NY 10023 Home: 212474 31-83 james.a.neumann@verizon.net Work: 212-201 4843 james,neumann@hvbamericas.com Mobile: 917-991 O,6 Please let us know if the documentation suite is complete or if there are any,questions. if a'site visit is needed,-it maybe performed at any time that fits the DEC's schedule. Thank you for your prO*, eritiion to this request. Sincerely James A. Neumann LOA a. W\lct M =.A M.. 1.0-0, 1:15 2.1 —N 15 01 Ll O TT w Aff(AA m 23 M4A 2-6 ♦ said Ll. oR —N— &.A 5.QA to 1�4 MA 2AI 27.7A(.) LOA WA.0 MATTt1UCR qeT. 1 7 0 TOM OF 11.4A.0 .2— I q I.A DO .5 Ob 113A 1.SE�c. w. —A ME 21 TO TN V 5 MAT. L E (2 NOTICE COUNTY OF SUFFOLK 1-� SECTION NO E SOUTHOLD G Red Property Tax Service Agency Y E C—ty Cmtx 1111.1-4 NY 11"I m 107 A N D P 1000 T. PROPERTY MAP k o c.K t�.xk"Q N �t kx-A �Ro PE RT� 1.o�1 = O rn k -To-Ev,1 Ijq MATT 1�u`K To P �Eti/ -LIB-- APPROVED BY 3 11g I 0'4 _ @ e,� BOAR® OF TRUSTEES C 4r�p TOWN OF SOUTHOLD (e.x►s "`�l DATE l _ C. �. E V MAR 2 6 2004 Tr Lo k'r Southold Town Board of Trustees I ! re- 9 w q V � �1 \ r2Sun k re S,n+� F t.0 4t T C @-X t S 4-1 nq Jl ,0,6 � 04 ha fh"I vo.OW 0 V YJJ ?vb 10 ,t 9 N X_ { 10' I 7 0 C. t� CuM�FN AO ►.�0.k . M�ArT I-Tut.K Nt.,€� `To P � t.E►n/ ' . 3 �14 � 0�4 n R 4 R? I [F2 LWE 6 2004 �o�t Southold Town Board of Trustees I I reSwA K �00,T tSTln ANN aT Y .. r M (}7 K I T(A, YK N I-Le °Q yew naW wc -- «._.__._..e. :M¢w^low W aer Mean Lav i 1 wa 11;� to r r T;d, F� P'1 i i Proper-T Permit Services POST OFFICE BOX 617, CUTCHOGUE, NEW YORK 11935-0617 (631) 734-5800 April 10, 2006 President Board of Town Trustees APR 1 8 2006 Town of Southold Town Hall, 53095 Main Road Southold,New York 11971 Re: Clarification of Permit No. 1253, Kathleen Neumann, SCTM#1000-107-1-1 Dear Sir: Attached is a drawing showing the dock structure as we understand it to be permitted. A previous request for an amendment was granted on 4/21/04 and the sketch submitted with the amendment request shows at the landward end of the structure an"existing ramp"which is not clearly defined in the sketch. The attached drawing clarifies and defines the ramp, which we now propose to re- construct as shown in the attached drawing. We would appreciate receiving the Trustees' acknowledgment and approval of this activity. If there are any questions, or if additional information is needed,please call me. Sincerely, / es E. Fitzgerald, Enclosures: Plan& Section Views -Dock,Rev 3/6/06 (3 copies) a subsidiary of THE PECONIC EASTERN CORPORATION U RELOCATED EXISTING FLOAT 6'X20' PROPOSED ADDED FIXED EXISTING FIXED WALKWAY 3'X48' LU LU WALKWAY TX20'� PROPOSED RAMP TO GRADE 1001 0 3'X15'± U m0 U,O t°I LL < < i i S. Alterniflora DELINEATED BY �O EXISTING FLOAT 6'X16' RELOCATED J.E. FITZGERALD ON 5l16/05 'CO ► EXISTING RAMP TX16' I FOUR SPILES SECURE FLOATS /RELOCATED I / I APR 1 0 2006 ► AHW ALW ----------- ----- ------ ----- --- --- -------------- ------- — -- /!/� /� r• AHW ALW GRADE TO DECKING: 5.5' 3.� ,4' 3.z' PILES IN AREA OF NEW CONSTRUCTION WATER DEPTHS AT ALW (3'X20'ADDED FIXED WALKWAY)ARE 10" DIAMETER, WITH 10' PENETRATION BELOW BOTTOM GRADE. SPILES SECURING FLOATS ARE 10" DIAMETER, WITH 10' PENETRATION BELOW BOTTOM GRADE. ALL DIMENSIONAL LUMBER, TIMBER, STREET ADDRESS OF PROJECT SITE: SCALE: 1" = 10' AND PILES ARE CCA-TREATED WOOD. 750 EAST MILL ROAD ALL HARDWARE IS GALVANIZED. MATTITUCK, NY 11952 CORPS OF ENGINEERS DATA PLAN& SECTION VIEWS -DOCK SEE SURVEY FOR LOCATION, ORIENTA- Application regarding the property of TION, PROPERTY LINES, AND NAMES OF PURPOSE:Extend existing dock for private Kathleen Neumann,SCTM#1000-107-1-1 ADJACENT PROPERTY OWNERS recreational purposes. Represented by PROPER-T PERMIT SERVICES DATUM:MLW P.O.Box 617,Cutchogue,NY 11935 IN:Mattituck Creek AT:Mattituck James E.Fitzgerald,Jr. 631-734-5800 COUNTY: Suffolk STATE:New York Rev March 6,2006 J SufFO(�- Albert J.Krupski,President ��� CMG Town Hall James King,Vice-President 53095 Route 25 Artie Foster ti P.O.Box 1179 Ken Poliwoda • Southold,New York 11971-0959 Peggy A.Dickerson 44 Telephone(631) 765-1892 ' 0,( � Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application �tland P 'cation Major Minor _Waiv r/Amendmen h ge Received Applica Qy ceived Fee:$ Completed Application 6 D _Incomplete _SEQRA Classification: Type I Type II Unlisted MAR 2 6 2004 _Coordination:(date sent) . _SAC Referral Sent: 3 ,d _Date of Inspection: Southold Town _Receipt of CAC Report: Board of Trustees _Lead Agency Determination: Technical Review: Public Hearing Held: VhF Resolution: Name of Applicant Address lolcs� �Na t9vc-eiw� APr � tC �Gw �(okk Phone Number:(p.tti) t-H-S t8 w tN k t - 2 o i 4 Suffolk County Tax Map Number: 1000 0 0 00 Property Location: '-5-0 t as (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Application GENERAL DATA Land Area(in square feet): 6k arcs Area Zoning: A Cy-e.. Previous use of property: tie; �"X Intended use of property: `�Ls ; ', g l Prior permits/approvals for site improvements: Agency Date 9z0 Z o- SokA,o I� down rus fees 61Je�lu„! Pzr,„ '# Sot I Lz' Is S- 10 1 3-0 f gS S . >EL 4 1- 1-13f c 1 -'s /0000 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): X 'PO'-A-1 0 n o-� 'b 0 c K L o �J�P W I ( r I g 4 $ inK i ' in for ��0a4rn 0 1Z0 }( L.. P W 1n .- 'a 0 0 �— y Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: t x L �z W TV C �F 1 n 4 l� S r O &p4- 2L4 ru L, y 1 ry x �Gn C i\ r n k �, l t✓l� e tom �to Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve 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 Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): ���� SUFFOL Town Hall Albert J. Krupski,President C. CMG James King,Vice-President h`Z` .f. 53095 Route 25 Artie Foster coP.O.Box 1179 Ken Poliwoda COD = Southold,New York 11971-0959 Peggy A. Dickerson �.fi� O�� Telephone(631) 765-1892 Fax(631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- D In the Matter of the Application of 9 2004 APR 1 om_�i"- -cm)----------------------------- Southold Town COUNTY Q ) /�E"' Boacd of Trustees STATE OF NEW YORK) AFFIDAVIT OF POSTING I, 731'QftLs Wv-fte"vo�' , residing at J© I Wts 4 �►�► 9� x i E IV" YQ'� IL ►J't 1 c 4 � L being duly sworn, depose and say: That on the day of 0-1 , 2004, I personally posted the property known as i s'a rgs 4 m M 'Re, A M,,, (4 ; --v lc i !)Y 11 cic—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 of the public hearing. Date of hearing noted thereon to be held ttWA, doll I at Oh a'b LU"F O,00 Nt, Dated: (signa e) Sworn to before me this r2 day of Q pf-l 200 4- Notary Public CATERINKtU E CHIONNA , IQOTARY PUBLIC,State of York No.01 ME6021196 New Qualified in New YorkCou* Commission Expires 0110610S 617.20 SEQR PROJECT ID NUMBER 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 ��rtEs A. A;�(L�ttnl� Ft�e� &PROJECT LOCATION: '4 5-d 6.as-� M,1( If\ Municipality N Y I I q S l County 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map s E-o .;. ri r I l 'K6"", Z M �: 4-,c,k T r lC- 5.IS PROPOSED ACTION: ❑ New ❑Expansion Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: 7.AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [0Yes ❑ No If no,describe briefly: 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑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 FYes Y (Federal, State or Local) ❑No If yes, list agency name and permit / approval: I d Sa���o lct tows( Tcks �s �t^� # t2s 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? Dles ❑No If yes, list agency name and permit / approval: S ems. a h c u e, 12. A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? Yes ❑No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name �1/t vh NJ t?"^,6L K Date: S l I$ l ® 7 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. 0 Yes o B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be uperseded by another involved agency. Yes o 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, potent ial for erosion,drainage or flooding problems? Explain briefly: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly N'a C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: �D 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: C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: 6' C6. Longterm,short term,cumulative,or other effects not identified in CI-05? Explain briefly: t3 C7. Other impacts(including changes in use of either quanti or type of energy? Explain briefly: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTA AREA CEA? If yes,explain briefl : ElYes No E. IS THERE,OR IS HERE 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 impactof 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 Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(If different from responsible officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: i�q. Lys a AM_ CZj,zn t�lac.1C Crud t-on Qe..�+ L.ro K c­'M L�ndcra1;%t C 1'10o G:Zs H•t( R—Ld #A l4:i s {t i :V 1( 9..r L S•.�e,ten b,ti k. v� W P 1 .aih LY .tir �► ; T r. 1 o Sz 6 64 "1 wry � c� J�M2s K-,n`"tP 4 M.l1 AIL le y� I M. I l �-a � '�'t I �,t-L STATE OF.NEW YORK COUNTY'OFSUFFePM 10Ecv �,+ ►„,► � �, ,. - ,residing at j a wes,l IVY t a o z3 ' '.--be ing duly sworn;deposes,and saysAhat on the. day.of AV- l ,.20 a 4 ,deponent mailed a true copy of the Notice -set:forth in;•the Board of Trustees Application,directed:fo each of the:above named _ _ P ersons at the addresses set opposite there respective names;.that fie addresses set.- opposite the;names of said-persons are the address of said persons.as shown on the current -:assessment roll of the.Towu of Southold;that:said Notices were mailed the United States Post Office at Lo Iw.,b,�, Vie AJ Y� Y 'that said Notices were mailed to each of said.persons by (certified) (registered)mail. Sworn to before me this h Day of A,Ili-,-1 ,20 4 tary Public CATERINA MELCHIONNA NOTARY PUBLIC,State of New York No.01 ME6021196 Qualified in New York County Commission Expires ©?A/1 Board of Trustees Application �E� 'iOY2K County of Suffolk State of New York .J MM e,c � _ '\I:et w►-%h n BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE 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. Si �ature SWORN TO BEFORE ME THIS til) DAY OF /4ga?G',N ,200Y Notary Publi CATERINKmELCHIONNA NOTARY PUBLIC,State of New York No.01 ME6021196 Qualified in New York C9 untj Commission Expires o 9�6�65 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. YOUR NAME: �l'Lc M A N N D A M E S 1 4 (Last name,first name,middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Variance Change of Zone Approval of plat Exemption from plat or official map Other (If"Other",name the activity.) 1`)oc.k I?er+h Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 1 g day of 1-1 ar c,h 200 `f Signature +u,_ A, 4 �- PrintName Tames A• ^12u•�a..�