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Home My WebLink AboutTR-6590E James F.King,President *QF SU(/TTown Hall Jill M. Doherty,Vice-President ,�0� Ol0 53095 Route 25 P.O. Box 1179 Peggy A.Dickerson J�[ Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. �O Telephone(631)765-1892 Ol�i��UNTy,� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD EMERGENCY WETLANDS PERMIT Permit No.: 6590E Date of Receipt of Application: April 23, 2007 Applicant: Robert Fox, c/o Kimogenor Point Company SCTM#: 1000-116-6-24.1 Project Location: Kimogenor Point Road, New Suffolk Date of Resolution/Issuance: May 3, 2007 Date of Expiration: July 1, 2007 Reviewed by: Board of Trustees Project Description: A temporary repair/resetting of the damaged bridge and railing to original position. Findings: The project meets all the requirements for issuance of an Emergency Wetlands Permit as determined by the Board of Trustees. The issuance of the Emergency Wetlands Permit allows for the operations as indicated on the application received on April 23, 2007. Special Conditions: A full Wetland Permit must be obtained in order to conduct any further activity on the bridge and/or other shoreline structures. This is not a determination from any other agency. D' James F. King, President Board of Trustees SOUTHOLD TRUS.TEES No. 1;6 6px+ Fox Issued T &4 &10 ' Date�� Address 8*jmeae.,�r Pet., -i��. itJe �.�)k THIS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION TOWN TRUSTEES OFFICE TOWN OF SOUTHOLD SOUTHOLD, N.Y. 11971_ TEL,.: 765-1892 ��'�,4'�'y �r a p'n ' �° u rP°°�ey fl Key NTS Prepared for: The Klmoyyenor Point Gompany Part of SGT# 1000-116-b-24.1 .r Gutchogue, New York S \ Tide Rancc7�e: 2 '+/- Datum: t�fSL-NCWD'2cl 9 1°= �O EI=30 I 9� SCALE TBkd E1=2 4 N� � X50 - E1=32 �dG -� TBkd r9\� Kim Pt. day - 5/6kd 36 ROQd------ P GOA\G B/Bkd EI=2 2 - 61 72 5�.3 EI=34 `hv �� Local Tidal Datum T40 d ry TBS 1) 57 TBkd O �� MHN oa Q• W \ TBkd 55 00 4 9 b.'' 1� EI=34 EI=22 + @� a d �4 �ho� N N TBI - 0 NGVD'29 - - 5/50 �`F TBkd BDatum + - -6 3 BBkd 3.4 Cp _ ;34 EI=36 MLW- -- I C7 EI=2.3 TB�d I Frame I1' 6 9S. TBkd ' I BulldinL� o) C11 LG. B/Bkd 3.3on p -YJ •-------------'- 1 I foundation I; 6 EI=23 EI=35 f� �1 E _ \ Floor L I -- -- Ct �' LU L TBkd Cj 2 J -55.0 El ; Iro ------------- ------ 'S \� I( '�_�L Ci BBkd 32 A 2t'll5 - -3 2 -- , , '2 L� --- -------- —' �0),v E1=22 E1=35 soU_il0 a To\411 -2 S Bora of TMiees 1 75 o p TB W --------------------- OW E1=03 — 0 C - EI-- 25 ` � kd -1 2005 May 1=35 EI=2.3 -0 pl EI=23 El=-O-7 EI=-08 =-Ol El=-0-1 El=-07 EI=03 t APR 2 3 2007 ��i, �i TBkd E1=34 EI=03 �10 c / y'9h A4 water EI=23 BYB3 39 � n, " �'� y 200 EI=0.2 E1=0.0 El=-O.O B/Bkd ��0; - --------------- -' E1=0 I Southhold Town 14 A\ 0-1 B%rth e, kl-2 z �o�\\'��,t _ ed e of march EI=2 4 Board of Trustees BBOd TBkd �qq BBkd v -1 ------------------ — TBkd 37 I b'.-' ----- -------------- - 4O E1=33 E1=3O - --2-------------- - ------------- ------ BBk TBkd --------- r 30 13/00d ------------- 4 TB3 gd d ----------- -- 12 EI-26EI=41 36 E1=34 BBkd ----- TBd O2 R 46 E1=46116-6-24.1 5GT#1000- Baku AHW&ALW BBkd B/Bkd i Land of Kimogenor Po1nt Go TBkd BBkd 36 -43 -25 36 -37 TBkd E1=2 bTBkd EI=29 EI=2q TB;d [j=30 TBkd EI=28 38 38 E1=30 i 36 PREPARED BYEI=30 EI=29 SEA LEVEL EI=26 E1=2-7 AMENDED 05-15-05 MAPPING THI5 PLOT NA5 DEVELOPED P o BOX a 538 FROM 5URVEY5 OF 0-7-30-04 RIVERHEAD,NY 11901 y ROBERT H FOX, NYS LIc# 501 PH 631-722-33905/13/2005 9 7,5q Sheet I Of I L"m 513 5pro G,�SLMVcImpt051305}�ro i ' ro o r U Il i c; 5 u rvFy Key Map � � � NTS Pre ared for: The Klmogenor Point Gompany Part of SGT# 1000-116-6-24.1 Gutr-hogue, New York S ° Tide Ranqe: 2.3'+/- % Datum: M5L.-NGVD'2L1 -7 q SCALE I -_ 30' E1=30 T/Bkd O\\L <O GOY,• E1=24 E1=32 T/Bkd 5\s�i Kim Pt. �Qy < P E1=22 B -12 2 B 3 EI=34 1;1 Local Tidal Datum T/Skd � �7 bio ` - �� 40 CV T/BO SZ T/Bkd �.00 MHN ^� 1 ! a i Lu �/Bkd 35 �o O — 0 34 9� �j i(n EI=22 hp + •d,0 �k a EI=34 T/SkQ ,` g o N6VD'2cl N \ kcdll �` �Q EI=3 2 �/; T/Bkd % R Datum B 47 6 3 �\ B/Bkd 54 ;34 EI=36 i47 ALL EI=23 T41 I f=rame I; 6 Y,y, T/Bkd Buildin m„) B/Bka 33 05 ' IL \ EI=2.3 E I=35 ounation EfFoor .0 , 5- 1L EI=2 3 - T� d AUG 2 J -------- - � B/Ba 2 4---- -32 -- - - E ZVU� I 1I i d EI=3s SGUttloi Town Board, of Trustees May i — TEI=25 E1=03 6 B - 3 2 -------- -- OW �1 j 1=35 EI=2.3 -0— E1=23 O EI=-01 E1=-0-1 EI=03EI=-08 1 E1=34 T/Bkd 2001 EI=03 'q(V M Y2 ater EI=23 B3 3'q APR 2 3 a EI=OI EI=0,2 EI=0,0 El=-O.O B/Bkd - "------ -------------- B/Bkd W @ BKD• °a B��mbe, k-1=2 2 ; �o��e,� _ ed e of marsh EI=2 4 outhhoi B/Bkd I4 AH T kd kheQa B/Bkd �� -1 S Trustees � ----------------- ----------------------------- _____ Boar I O kd � 18,- � ,' - -- - ---_ - T/B 3 EI=3 3 '' EI=3 0 i 40 --2.------------ B�0 TA3 B/Bkd T46 EI=3q ---------------------- ----------- ----- qd 12 46 EI=41 T/Bkd ----------- 5b -4 + EI=3 4 B/Bkd EI=2 6 T/Bkd 02 46 E1=46 SGT#1000-116-6-24.1 AHW&ALW BBkd B/Bkd � Land of Kimogenor Po1nt Go. T/Bka B/Bkd BBkb @ 130. -4 3 -2 s 36 ��, -37 T/Bkd EI=2 8 T/Bkd EI=2 q EI=2 q T�7d P1=3 0 T /Bkd E1=28 3 8 3 a E1=30 36 PREPARED BYE1=3 o EI=2 q AMENDED SEA LEVEL EI=26 E1=2-1 05-13-05 MAPPING THI5 PLOT WAS DEVELOPED P o.Box#538 FROM 5URVEY5 OF 07-30-04 RIVERHEAD,NY 11901 ROBERT H. FOX, NYS Llc# 50197 PH 631-122-33G0 Sheet I Of I 5/13A2005k1m r,sa a2 G,�SLM\klmpto513os proro a �e �''o r p � � u ��P�e�� ;li°� ` Key Map NTS Prepared for: The Klmogenor Point Gompany Part of 5GT# 1000-116-6-24.1 Gutchogue, New York 'S ° Tide Rancc�e: 2.3'+/- Datum: M5L-N61/D'29 (p" e o EI=3 0 95 I P VO SGALE I = 30 TBkd ) `� 9°moi N�P`�� B/gfd 53 9 �F0\O\� E1=2 4 Q, O� �g EI=32 � TBkdK g\� �- B/t3kd - \L Pt. 3 6 ROQd POGO J � Iq BBkd EI=22 --12 B/53 EI=34 9 O� Local Tidal Datum �l T-p N T�� 7 A TBkd o 'OO 'MHN 0" 4 9�� EI=2 2 o Ga EI=34 TB�a 4• �� y�U q __ o N6VD'29 EI=3 2 % �? Datum kd i.� / TBkd 2 + O B6 3 BBkd 3.4 C i Cp -34 EI=36 i 7 Y MLW "E I=2.3 � 1 TB� / Frame TBkd Buildin n�u1 BBkd 3.3 fM, On p05 E'� -3.4 I) ,(p •------------ / foundation �; a o EI=23 EI=35 I / Floor 1 - -6 - f I Flev. = 5.0 EI=23 2005 I -Gj TBkd AUG 2 J _ I; .Ac ----------- ------- ------ – ---------------- 4- - ; 3 ----' ;I -"_______-__ _ I=2z SouthodTawn , - -2 - 'o ------- EI=35 i E ' 75' 6, TB W In ` — - - - O E1=03 t C y EI-25 7 kd --1 w � 2005 �, - � �� E1=27 BB d 32 May i 1=35 EI=23 -0 - i EI=23 E1=-0-1 J G v ; -A o� EI= APR 2 3 2007 El= 08 EI=-o7 EI=0.3 `40,, (j TBkd EI=34 EI=03 �D �/ High water EI=23 gy8kd 3-9 EI=o-1 `L�% MaY20p5 _ -33 Southhold Town EI=0,2 EI=O.o EI=-0.0 BBkd �� ' Board of Trustees BBkd W @ P,K� °9 g��mbe� k-1 2 z vo\l v�'� - ed e of marsh E1=2 4 BBkd 14 PN TBkd �heQq BBkd ; v� - 1 0 TBkd -3-1 --------------------------------------------------------------- - 4 0 E1=3 3 '' E1=3 0 ( ---------2------—-------- -----------------------------------" __ -' - 50 BBkd BBkd TBkd E1=3CI --------- ---------- -------- 3 1 2 4 6 EI-4 1 TBkd - -3 4 EI=2 6 ' TBkd 36 EI=34 1 BBkd --------- TBkd o2 1 46 EI=46 1 5C-f#1000-116-6-24.1 AHW&ALW BBkd BBkd Land of Kimogenor f oint Go. TBkd B-51 �66••. @ BKD. -43 -25 3 6 \ BB t TBkd r1=3 0 TBkd E1=2 8 T-5.5 EI=2 8 T/BSd EI=29 EI=29 37 E1=30 36 PREPARED BYEI=3o EI=29 AMENDED SEA LEVEL EI=26 E1=2-7 05-13-05 MAPPING THIS PLOT WAS DEVELOPED P.O.BOX#538 FROM SURVEYS OF 07-30-04 RIVERHEAD,NY 11,101 ROBERT H. FOX, NYS Lir- 501q-7 PH 631-122-3390 "; 5/15/2005 '1,09,42PM Sheet I Of I C,\6LM\kImpt05I505pro !f James F.King,President �QF S0 -Town Jill M.Doherty,Vice-President 53095 Route25Peggy A. Dickerson P.O.Box 1179 Dave Bergen COO yC Southold,New York 11971-0959 On Bob Ghosio,Jr_ �O Telephone-(631)765-1892 00UN11 ' Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Work session Report Date/Time: ROBERT FOX C/O KIMOGENOR POINT requests an Administrative Permit to repair damage to the existing 6'X 90' bridge. Located: Kimogenor Point Rd., New Suffolk. SCTM#116-6-24.1 Tie of area to be impacted: _Saltwater Wetland Freshwater Wetland _Sound Bay Distance of proposed work to edge of above: Pmt of Town Code proposed work falls under: V_Chapt.275 Chapt. 111 _other Type of Application: Wetland_Coastal Erosion_Amendment '"Administrative _Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: _J.King _J.Doherty P.Dickerson D. Bergen B. Ghosio, Jr H. Cusack D. Dzenkowski Mark Terry other Mailed/Faxed to: Date: Environmental Technician Review AUb CC(4w ec4c ng �s wa�,� a I I 0-LA 04- w 34er- = James F. King, President ��0� soyo Town Hall Jill M. Doherty,Vice-President 53095 Route 25 Peggy A. Dickerson P.O. Box 1179 Southold,New York 11971-0959 Dave Bergen G Q Bob unosio, Jr. Telephone(631) 765-1892 COU 11 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application -)( Administrative Permit / _AmendmenbTrans er/Extension v ReceivedApplication: Yf q30� -/Received Fee:$ Qo— _eCompleted Application HIM169 �•.•.....�.. _Incomplete _SEQRA Classification: - Type I Type II Unlisted —Coordination:(date sent) A, �� ` ? �� —LVW Consistency Assessment Form II�"ii((' �"L _CAC Referral Sent: ,Date of Inspection:Kilo _Receipt of CAC Report: $ s _Lead Agency Determination: _Technical Review: Public Hearing Held: QJ[610 Resolution: Name of Applicant - p Address p2e2�0 ( f_1,A,2 f`Cr` _i�W . CT o(ok7!7 Phone Number:(d . . 62� Vo Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: NA (provide LILCO Pole#, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: rd of Trustees Applicatic , GENERAL DATA Land Area(in square feet): am % t*\[ - - Area Zoning: Previous use of property: Intended use of property: SAPhe, Covenants and Restrictions: Yes No If"Yes", please provide copy. Prior permits/approvals for site improvements: Lie Agency Date 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): &I / ' r7 7107 S" , . O � 5 or 'ard of Trustees Applicat WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: got PM N-W -1 44d tIM "toe . Area of wetlands on lot: Dov S square feet Percent coverage of lot: ®, ~f % Closest distance between nearest existing structure and upland edge of wetlands: 0 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? I 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: 0 % 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): &t 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 K ID 3.PROJECT LOCATION: MunicipalityNEWCounty 4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map P/Jr11�J 5.IS PROP ED ACTION• ❑ New ❑Expansion ❑Modification/alteration 6 DESCRIBE PROJECT BRIEFLY. -rJ40 }}— �d Nir 'V- e, C to ' IC4 9�6 a7 b ' �I,c� �►�-� ��? �'i.ecrr � r� scd�.- lYa nom, 5 ov" 4, /0 d 0111 S►r Sl�''�e� �l 7 AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? MYes ❑ No If no,describe briefly. 9.WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) zResidential ❑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 CURRENTLYVALID 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? ❑Yes ❑No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TOT BEST �OF MY KNOWLEDGE Applicant / Sponsor N m,,,,RLN"� l.. ,p�{, �il �i s �" l Date. 0? 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) f�/P A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate/e review process and use the FULL FAF. 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 0 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: C2. Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources,or community or neighborhood character?Explain briefly F- . . I I C3 Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly 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 C6. Long term,short term,cumulative,or other effects not identified in C1-05? Explain briefly C7 Other impacts(including changes in use of either quantity or type of energy? Explain briefly D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEA)? If yes,ex Iain briefly Yes n No E IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex Iain Yes No i 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,r#te-deterrniaatioR-efsigni€iGanGe-rnustevaluate-the-pstentiahmpaet-oftheprepesed-aetie"n-theerrvtr-onrnentaf-char-aeteristtes-o the(-EA 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 actio WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting tht determination. Name of Lead Agency Date Print or Type Name of Responsible Officer to Lead Agency Title of Responsible Officer Signature of Responsible Officer to Lead Agency Signature of Preparer(If different from responsible officer) Board of Trustees Application County of Suffolk State of New York 5% L4 M �� -` BEING DULY SWORN DEPOSES AND AFFIRMS TIYAT 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 RE W OF THIS APPLICATION — . — rSigna e SWORN TO BEFORE ME THIS 23 tia DAY OF Afazz l 12007 John M.Judge NOTARY PUBLIC,State of New York (-V- No.01JU6059400 Qualified In Suffolk county ticdary Public Commission Expires May 29,20 77 iard of Trustees Appli.cat, AUTHORIZATION (where the applicant is not the owner) I. residing at (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town Trustees on my behalf. (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, l^ f YOUR NAME C (Last name,first name,-piidM' itial,unless are applying in the name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning , Other R�� (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); 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 day 2002 Signature _ Print Name gap foalC -{" C' /-y,✓ Form TS l