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HomeMy WebLinkAboutTR-5987AAlbert J. Krupski, President James King, Vice-President Attic Foster Ken Poliwoda PegKy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 5987A Date of Receipt of Application: August 30, 2004 Applicant: Hugh Switzer SCTM#: 67-5-2 Project Location: 2700 Mill Rd., Peconic Date of Resolution/Issuance: September 22, 2004 Date of Expiration: September 22, 2006 Reviewed by: Trustee Peggy Dickerson Project Description: To replace in-kind a failed septic system. Findings: The project meets all the requirements for.issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the attached survey prepared by Stanley J. Isaksen, Jr. last dated August 9, 2004. Special Conditions: None If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the $outhold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Albert J. Krupski, Jr., President Board of Trustees -39 I S 28'00'00"E MILL ROAD MAP FILED JU,~IE 6. 1926 F','O LOT 15 S: LOT 16 OF PROPERTY OF BLANCHE T. DICKERSON PECONIC, TOWN OF SOUTHOLD SUFFOLK COUNTY, N.Y. SURVEYED FOR: 2700 MILL ROAD LLC SURvE?L£, 24 OCTOBEP SCALE 1"- 50' APEA = l=,O90 14 S ? 0 392 ACP~S Albert J. Krupski, President James King, Vice-President Artie Fester Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Coastal Erosion Permit Application __Wetland pernut Application Waiver/Amendment/Changes ;K~ceixYved Application: ~1~ .~eceived Fee:$ ~/ -%'%mpleted Application Incomplete __SEQRA Classification: Type I Type Il Unlisted Coordmation:(date sen,~ '~"CAC Referral Sent: --,-dSate of Inspection: Receipt of CAC Report: Lead Agency Determination:__ Technical Review: Hearing Held: Resolution: Office Use Only Major Minor AUG 3 u 2nn4 $outhold Town Board of Trustees Name of Applicant Address ~ I ~TCD~ Suffolk County Tax Map Number: 1000 - PropertyLocation: 2._-'fc..hq_~ ~ ,q_~. (~ / ~)~'Cc'%~._~lC.; ?'3"4 (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: tgex-,-~l% t3 '4 I Ict5'~ Phone: (-~ t --7'~-'--- ?'7'/"7 B~oard of Trustees Applicatio~ Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend/ed by a governmental agency? ~,/No Yes If yes, provide explanation: Project Description (use attachments if necessary): WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot:~~.~quare feet Percent coverage of lot:/:~P~¢: ]~) % Closest distance between nearest existing structure and upland edgeofwetlands: ~. t-~- feet Closest distance between nearest proposed structure and upland edge of wetlands: ~'~ F___ e~r'- feet Does the project involve excavation or filling? No ~ Yes If yes, how much material will be excavated? 3 ~ 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:/JT/:~j~l 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): ~rd of Trustees Applicatio~ COASTAL EROSION APPLICATION DATA Purposes of proposed activity: ~fff>cOff----~_ I ~3 1(-.-~ ~-~ ~e wetlands present ~thin 100 feet of the pro~sed a~ivity? No ~ Yes Does the project involve excavation or filling? No / Yes If Yes, how much material will be ex~vated? ~ O (cubic yards) How much material will be filled? ~ ~ (cubic y~ds) 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) PROJECT ID NUMBER )ART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 3.PROJECT LOCATION: Municipality 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification / alteration DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LANAN~) AFFECTED: Initially . O ~acres Ultimately , O ~ acres 8. W1LL PROPOSED ACTION COMPLY W~TH EXISTING ZONING OR OTHER RESTRICTIONS? ~3Yes [] No If no, descdbe bdefly: WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~lResidential [~lndustrial [~Commercial r--]Agriculture [~Park/Fo~est/OpenSpace [~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 r~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E~Yes [~No I CERTIFY THAT THE iNFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant/ Sponsor Name ~'-(,~ 6-~"('-' ~J"-~ IT~-'~-~-~ I Date: Signature~"~'-~ ~Y~~~ eRC If the actien is a Costal Area, ~n~ you are a state ag y, complete the Coastal Assessment Form~efore proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lenc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.47 if yes, coordinate the review process and use the FULL EAF. L WiLL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR. PART 617.67 If No, a negative declaration may be superseded by another involved agency. I--lYes []Ne C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, it legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing t~affic pattern, solid waste production or disposal. potential for erosion, drainage or flooding problems? Explain bdefiy: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighbo~ood character? Explain briefly: C3 Vegetation or fauna, fish. shetifish or wildlife species, significant habitats, or threatened or endangered species? Explain bdefly: C4. A communiys existing plans or goals as officially adopted, or a change in use ir intensity of use of land or other natural resources? Explain briefly' C5. Grove, h, subsequent development, or r~lated acti'~itle$ likely to be induced by the proposed action? Exptain briefly: I C6. Long term, short term, cumulative, or other effects not identified in C1 -C57 Explain briefly: I C7. Other impacts (includin~l chan~es in use of either (~uantit~ or b/pe of ener~l¥? Explale brieti;/: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? IIf )'es, explain briefl)': E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If)'es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edabeve~determinewhetheritissubstantia~'~arge~important~r~therwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irrevemibil[ty; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detaii 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 mom potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL 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, thai the proposed actio 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 Title of Responsible Officer Signature of Preparer (If different from responsible officer) Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency of Trustees Applica County of Suffolk State of New York ~'~LI. ~7~ lJr ~ ~t'~ X"~-x~-{~ ~ BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN 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), I]7 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. SWORN TO BEFORE ME THIS i{~lature ,20 Notary Pu ' APPLiCANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM ¢ Town f ol ' f thic lb'ts co fli in n the f n em . f . ~tto ~whateve act]un ~s t i t(rm ' ' ' * YOUR NAME: (Last n~, firs~aine, galddle initial, unless you ar~ applying n the ,~ 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.) Building Tax grievance Trust~ Variance Coastal Erosion Change of Zone Mooting Approval of plat Planning Exemption from plat or official map _ (If"Other", name the activity.) _ Do you personally (or through your company, spouse, sibling, panmt; or child) have a relationship with any officer or emplo, yee ' ' ss interest- "Business interest" means a baswa:ss, of the Town of Southold? "Relationship" includes by blood, mamage, or ousme iocluding 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 shams. so YES 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 ali that apply): _ ._A) the owner of g~ater than 5% of the shams of the corporate stock of the applic*nt (when the applicant is a corporation); __.B) the legal or beneficial ownS' of any interest in a non-co~porate entity (when thc applicant is not a corporation); ~C) an officer, director, partner, or employee oftbe applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted thi~L_t~_ day of ~('-,{' IX '/-~ 200 d Signature_ Print Name To: Board of Trustees, Town of Southold From: Hugh Switzer 3180 Mill Lane PO Box 283 Peconic, NY 11958 , ~ ,~k~25, 2004 Subject: Request for Administrative Waiver to replace-in-kind a failed septic system located at 2700 Mill Lane, Peconic, NY 11958. The subject septic system is very old (approximately 50 years) and is now failing. It has overflowed 4 times in the last 6 months, each time requiring pump-outs. The overflow endangers the safety of Goldsmith Inlet. The plan is to close/abandon the 2 cesspools that are closest to the Inlet (reference enclosed survey) and only utilize those closest to the house and farthest from the Inlet. Specifically, we will replace the failed septic tank (near the house) and at the same time install a second cesspool to ensure the effectiveness and longevity of the system. Full environmental impact mitigation measures will be employed during the project including hay bales and flexible plastic screening around the Inlet perimeter. Thank you in advance for your prompt response. Please call (765-3296) if there are any questions.