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Home My WebLink AboutTR-6274A . . James F. King, President Town Hall Jill M, Doherty, Vice-President 53095 Route 25 Peggy A. Dickerson P,O, Box 1179 Southold, New York 11971-0959 Dave Bergen Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 6274A Date of Receipt of Application: January 9,2006 Applicant: Mary Reidy SCTM#: 115-17.15 Project Location: 3000 Deep Hole Drive, Mattituck Date of Resolution/Issuance: January 18, 2006 Date of Expiration: January 18, 2008 Reviewed by: Board of Trustees Project Description: Permit to cut the Phragmites to 1', as necessary, with the condition that there be an inspection after one year, in January 2007, as per plan approved by the Board January 18, 2006, Findings: The project meets all the requirements for issuance of an Administrative Permit set forth by the Board of Trustees. Special Conditions: One-year inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth by the Board of Trustees, a Wetland Permit will be required. This is not a determination from any other agency. ~~~ James F. King, P sident Board of Trustees . . James F. King, President Town Hall Jill M, Doherty, Vice-President 53095 Route 25 Peggy A. Dickerson P,O, Box 1179 Southold, New York 11971-0959 Dave Bergen John Holzapfel Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: 'MOflJ ~-~ J&." <1'/ 2006 Please be advised that your application dated has been reviewed by this Board at the regular meeting of -r-",,.,, l~ ? DO' and the following action was taken: , ( /) Application Approved (see below) ~) 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 Chapter 97 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: r: nt. I I h if-<- c....f,b0J TOTAL FEES DUE: $ SO BY: James F. King, President Board of Trustees . . James F. King, President Town Hall Jill M, Doherty, Vice-President 53095 Route 25 Peggy A. Dickerson P,O, Box 1179 Southold, New York 11971-0959 Dave Bergen John Holzapfel Telephone (631) 765-1892 Fax (631) 765-6641 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. 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Krupski, President Town Hall James King, Vice-President 53095 Route 25 Artie Foster P,O, Box 1179 Ken Poliwoda Southold, New York 11971-0959 Peggy A, Dickerson Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application _Wetland Permit Application l Administrative Permit Amendment/Transfer/Extension /Received Application; II q lOr" vReceived Fee:$ SO' ~mpleted Application II 9 !Qf. _Incomplete _SEQRA Classification: ~.".._-- Type I_Type II_Unlisted_ _ Coordination:( date sent) _L WRP Consistency Assessment Form -- ~ 2005 CAC Referral Sent: . JAN ~ate ofInspection; 1111 I OJ, _Receipt of CAC Report: . _Lead Agency Determination:_ Technical Review: .-0"ublic Hearing Held: I /1'KIOt-. _Resolution: f ' Name of Applicant f1/}~V 1<1:1 by Address :Booo Dee' P HoLE bR)Vc MAlT ITt/ (~ Ie Phone Number:(~3b d.9~-Lk, / ~ - Suffolk County Tax Map Number: 1000- 1/5-/7-/'3 Property Location: t/i/ wdLF A/flJJ Su F rOLk',1t ve 'WCftN1 La1' . _ _ .(provide LlLCO.PQk #~distance to cross streets, and location) AGENT: (If applicable) Address: Phone: - 4Ifoard of Trustees APplica..,n GENERAL DATA Land Area (in square feet): .il ~ Area Zoning: A.e<t-/444kL Previous use of property: VI~rJ:-; Intended use of property: ~ Prior permits/approvals for site improvements: Agency Date J No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspe~d by a governmental agency? . No Yes -- If yes, provide explanation: Project Description (use attachments if necessary): 4IJoard of Trustees APPlica~ , WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: -/ ed / '~ - rU Area of wetlands on lot: If '5' 0 7 square feet 't )( 50 PHItAc.MiTfu.' Percent coverage oflot: 5" - /.6 % Closest distance between ~est existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: f\J A 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 tile town that may result 1J}' . reason of such proposed operations (use attachments if appropriate): 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 ---- R F:.tJ) L'..) 3,PROJECT LOCATION: Municipality (I1fJ ~;rOLI( County S rro f-k 4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ate - or orovide maD l3/Ef lfolE. , 3000 I/E 5. IS PROPOSED ACTION: ~ New o Expansion o Modification I alteration 6. DESCRIBE PROJECT BRIEFLY: 70 17r(M /lIE ?IhfIfAAllEs b~..u 7l> l?- I FtX1T 11t/&/l1 /f.s /lLLbWe~ Sf fEtl1;-r,- 71/Is WOi.ll..j) AU", US /IN ~ t)t/~ IV;;j &/I,sol2.s "h $eE o ~R/77IF-~ t',f.#;1/l1 C-lIitJ-REAJ Wll/LE 'l1IEY !fILE IA) TlfE ~~,C 'L-S S '/f L. SITu (,AJ - 7. AMOUNT OF LAND AFFECTED: Initially /acres Ultimately acres 8, WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? E0:es o No Jf no, describe briefly: 9, WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~ReSidentiaf o Industrial o Commercial DAgricu,ture 0 Park I Forest I Open Space OOther (describe) 10, DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR UL TIMATEL Y FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes ~o If yes, list agency name and permit I approval: 11, DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? DYes ~o If yes, list agency name and permit I approval: PROPOSED ACTION WILL EXISTING PERMIT / APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant .:J/I J/1~ F !fEf}Y Date: 1 - t}, - 06 Signature efT If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment . . i PART II - IMPACT ASSESSMENT (To be comDleted bv Lead Aaencvl 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. DYes ONo 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. DYes ONO C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, suriace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: I ! C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I I C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land o( other natural resources? Explain briefly' I I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: t I e6. Long term, short term, cumulative, or other effects not Identified in C1~C5? Explain briefly: I I C7. Other impacts (including changes in use of either ouantitv or tvne of energy? Exolain brieflv: I I D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA)? (II yes, explain briefly 1 DYes D No I E IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? II yes explain: D Yes DNa II PART 111- 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 directty to the FUL EAF andlor prepare a positive declaration. Check fhlSbox-ifyou-flave-detiirmmea';hasedon -thel'nformation and analysis above and any supporting documentat!()n,'thatthe-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 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) 4It Board of Trustees APPliC~ion County of Suffolk State of New York -.:MMES F RG. ;.by 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 IDS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN TIDS 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 TIDS APPLICATION, I HEREBY AUTHORIZE THE 1RUS1EES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO EN1ER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF TIDS APPLICATION, cfl ~~ ~-~ Signature SWORN TO BEFORE ME THIS I(? +f: DA Y OFJ~'20 (X:. '~7>1~ Notary Pub 'c MELANIE OOROSKI NOTARY PUBLIC, State of New 'rblk No, 01004634870 Qualified in Suffoik Counl1'. ~ IV Commission Expires September 30f' ~'-":> . . .' APPLICANT/AGENTIREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics nrohibits conflicts of interest on the Dart aftown officers and emolovees. The om:pose of this form is to nrovide information which can alert the town ofoossible conflicts onnterest and allow it to take whatever action is necessarv to avoid same, YOUR NAME: Rf;t>Y .J1I'rl1 ES F. (Last name, first name, J1liddle initial, unless you are applying in the name of someone else or other entity, such as a company. Ifse, indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply,) Tax grievance Building Variance Trustee V' 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 bus'iness 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 57ares, 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 South old Title or position of that person Describe the relationship between yourself (the applicant/agenUrepresentative) 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 applicl;lnt (when the applicant is a corporation); ~B) the legal or 'beneficial own~r of any interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer, director, partner, Of employee of tile applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP S~bmitted ~ e. Yf/ day of ~ ~. 200'- Form TS I - ~~::~~~ ~.~ ty