HomeMy WebLinkAboutTR-6133
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
CERTIFICATE OF COMPLIANCE
# 0204C
Date Mav 23. 2007
THIS CERTIFIES that the in-ground swimming pool. patio. fence. pool drvwell and non-turf
buffer
At 1160 Goose Creek Lane. Southold,
Suffolk County Tax Map # 78-8-5.1
Conforms to the application for a Trustees Permit heretofore filed in this office
Dated 4/27/05 pursuant to which Trustees Permit # 6133Dated 5/18/05
Was issued, and conforms to all of the requirements and conditions of the applicable
provisions oflaw. The project for which this certificate is being issued
is for an in-ground swimming pool. patio. fence, pool drvwell and non-turf buffer.
The certificate is issued to GRAHAM HEAD owner of the
aforesaid property.
~~~
Authorized Signature
Albert J. Krupski, president.
James King, Vice-President
Artie Foster
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 SOUTH OLD
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
1 sl day of construction
% constructed
,/' Project complete, compliance inspection. $\ \<;101. ~
,..-;;-
.
.
PART 11- ENVIRONMENTAL ASSESSMENT 1T0 be comnleted bv Anency) .
A DOES ACTION EXCEED ANVTVPE I THRESHOLD IN 6 NVCRR, PART 617.12? If yes, coordinate the review process and
use the FULL EAF.
o Ves ONo
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NVCRR, PART 617.6? If No,
a negative declaration may be superseded by another involved agency.
o Ves 0 No
C. COULD ACTION RESULT IN ANV ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten,
Illegible)
C 1. Existing air quality, surface or groundwater quality, noise levels, existing traffic patterns, solid waste production or disposal,
potential for erosion, drainage or flooding problems? Explain briefly:
C2. Aesthetic, agricultural, archeological, historical or other natural or cultural resources; Of community or neighborhood character?
Explain briefly:
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitat. or threatened or endangered species? Explain briefly:
C4. A community's existing plans or goals as officially adopted, or change in use or intensity of use of land or 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-C5? 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 CEA?
OVes ONo
D. IS THERE, OR IS THERE L1KEL V TO BE, CONTROVERSV RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS?
OVes ONo If yes, explain briefly
PART 111- DETERMINATION OF SIGNIFICANCE (To be compleled by Agency)
INSTRUCTIONS: For each adverse effect identified above, datermine whether n 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; end (I) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts hava been identified and adequately addressed. If question 0 of Part II was checked yes,
the determination and signifICance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
U Check this box II you have identified one or more potentially large or significant adverse impacts which MA V occur. Then proceed
directly to the FULL EAF and/or prepare a positive declaration.
o Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the
proposed action WILL NOT resull in any significant adverse em.;ronmental impacts AND provide on attachments as necessary, the reasons
supporting this determination:
Name of Lead Agency
Print or Type Name of Responsible Officer
Tille of ResponSible Officer
Signature of Responsible Officer in Lead Agency
Signature of Preparer (if different From responsible officer)
2
Suffolk Environmental Consulting, Inc.
Newman Village, Main Street, P.O. Box 2003, Bridgehampton, New York 11932-2003
(631) 537-5160 Fax: (631) 537-5198
Bruce Anderson, M.S., President
March 29, 2005
~(L~ ~JJL1~1
In 1. II I R " ; onol; ".
U U~ lii:i' v '~~iUJ i
L__.. -
Mr. Albert J. Krupski, President
Town Hall
P.O. Box 1179
Southold, NY 11971
:.'il
Re:
Situate:
SCTM #:
HEAD Property
1160 Goose Creek L~ne; Southold, NY
1000 - 078 - 08 - 005
r'c'"s -,
' , " fe '(1- ('\1\
'f1t II
Dear Mr. Krupski,
This Firm represents Mr. Graham Head, owner ofthe above referenced parcel, who wishes to
improve thereon. Enclosed herewith for your review please find the following materials:
(1) Survey of subject parcel prepared by FOX LAND SURVEYING, last revised
March 22, 2005, indicating all existing and proposed structures thereon
(two [2] copies);
(2) Photos showing the staked locations of the proposed structures and the wetlands
(two [2] sets);
(3) Location map (two [2] copies); and
(4) Authorization;
On behalf of Mr. Graham Head, I request a Letter of Non-Jurisdiction pursuant to ~ 97-12 (D) (I)
(a) of the Southold Town Code, in that the proposed pervious driveway is situated beyond 50.0'
rrom the edge of wetlands; the proposed sanitary leaching pools are situated beyond 100.0' rrom
the edge of wetlands; the proposed septic tank is situated beyond 75.0' from the edge of wetlands;
and the proposed swimming pool situated 50.0' from the edge of wetlands. Kindly forward the
requested Letter of Non-Jurisdiction directly to this office. Please feel free to contact this office
should you have any questions or require additional information concerning this matter.
Sincerely,
Matt D. Ivans
enc.
cc: G. Head
OWNER'S ENDORSEMENT
(TO BE SIGNED IF APPLICANT IS NOT OWNER)
STATE OF NEW YORK)
COUNTY OF SUFFOLK) 55:
GRAHAM HEAD, being duly sworn, deposes and says; I reside at
55 WALKER STREET - APARTMENT 5A; NEW YORK CITY
In the County of NEW YORK and the state of New York
and I am the (owner in fee) (officer of the Corporation which is owner in fee) of
the premises described in the foregoing application and that I have authorized
Suffolk Environmental Consultin$l, Inc.
to make the foregoing application as described herein.
Signa
Signature
If Corporation, name of corporation and Officer
Officer s Title
8"'''
Before me, this~day of
.::r-c:...nv~ ' 2005
~..Of~
Notary Public
,',l..'"
'-.,: \, l)l~j. :i"w d NtWJ Von
i'JO. ;j.i~4J46B/4
Qualified in New York County
Commission Expires Aug. 31, 2005
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