HomeMy WebLinkAboutTR-6275A
. .
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.: 6275A
Date of Receipt of Application: January 9, 2006
Applicant: James Reidy
SCTM#: 115-17-16
Project Location: 2960 Deep Hole Drive, Mattituck
Date of Resolutionllssuance: 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.
l=F~~",
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: ~( r {)rrJ.o 10:(~
Please be advised that your application dated ~,. q, ;!.o,t has been
reviewed by this Board at the regular meeting of J'0n_ (I( 2. 0'" and the
following action was taken:
( J) 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: ~'hP\1 <'0 ~'I"'"
I h.l ru+-'"
sO
TOTAL FEES DUE: $
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.
INSPECTION SCHEDULE
_ Pre-construction, hay bale line
_ 1st day of construction
Yt constructed
~ Project complete, compliance inspection.
.
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Albert J, 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. Dickeraon Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Oflice Use Only
Coastal Erosion Permit Application
Wetland Permit Application L Administrative Permit
Amendment/Transfer/Extension
/ReceivedApplication: 119/~
/Received Fee:$ ,~
~ompletedApplication 1/9 /Or..
,
_Incomplete
_SEQRA Classification:
Type I_Type Il_ Unlisted~ J~~ - S 2000
_ Coordination:( date sent)
_ L WRP Consistency Assessment Form
_ CAC Referral Sent: I/ft/Oj,
~ate of Inspection:
_Receipt of CAC Report:
_Lead Agency Determination:_
Technical Review:
,-public Hearing Held: I / J V fD(,.
_Resolution: .
~
Name of Applicant J/l mf S RfID~
Address dJ/ r; 0 j) t: e{> /i1J CE D,e, f'vIlt-rf/ TV U(
Phone Number:(~'3i ;),1[- <f(p/d..---
Suffolk County Tax Map Number: 1000- //5 - 17-J(.
Property Location: ~
(J{k.:
AGENT:
(If applicable)
Address:
Phone:
4Itoard of Trustees APplica~
GENERAL DATA
Land Area (in square feet): , ).~ /-! citE'
Area Zoning: ~~L
Previous use of property: ~h-vL
Intended use of property: ~
Prior permits/approvals for site improvements:
Agency Date
/ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or SUSP/d by a governmental agency?
_No_Yes
If yes, provide explanation:
Project Description (use attachments if necessary): 4
d<t , :t
thL _~ ~~??./~ ~ - ~ a. /rr-
~~
- ~
4Itoard of Trustees APPlica~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: ,kcd~~ ~
~/~ - d.{}, (/71- ,~ ~/
Area of wetlands on lot: #50 square feet 1X56
Percent coverage oflot: S-IO %
Closest distance between nearest existing structure and upland
edge of wetlands: Iff feet
Closest distance between nearest proposed structure and upland
edge of wetlands: /J II feet
Does the project involve excavation or filling?
V 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 wetl~ds and tidal waters of the town that may resu1t1JY:
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 I SPONSOR REr bY 2. PROJECT
...J7t ME ..s
3,PROJECT LOCATION:
,
Municipality r-tl 77/e... County
4. PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ete - or provide map
J.1C,o p~Ef!lOL~ ~~fr-;VE hilT, 'Tt.Jc....k
5. IS PROPOSED ACTION: ~ New o Expansion D Modification I alteration
6, DESCRIBE PROJECT BRIEFLY:
7(; /1<;/11 rilE- :p II f[ A-& f'1 i'7eI:. I>oWIJ To It //Y;oT
!I~i~tf T -/JS WIU' I1LWWcb Ii E-'t..:r tx>o ~. 11/IS
W() II L.b 1ft-LoW ~ frU .t> OI.IR Nfi.iW8o~ ft ~IUE- m
{}j(1J Nt:. (!j/-it-b RrvJ PUlY itUt!s- ;;.1 T1-fF e...~EEK. frlSo WE
;/PIE 17//$ .. f( IiJ:, U(!E , fRof3LEM.
Wl/..{., TJ.I.t::... e...
7. AMOUNT OF LAN~FECTED:
Initially a es Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~es o No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply,)
~ Residential o Industrial DcommerCial DAgricu,ture D Park I Forest I Open Space DOther (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 a{NO If yes, list agency name and permit I approval:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
DYes tzlNO If yes, list agency name and permit I approval:
12. AS A RE ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
[]yes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I Sponsor Name .::r-/ltlfc S F irE/bY Date: 1- C;; -()~
~ .
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.
DYes DNa
8, 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 DNa
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:
I 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 or other natural resources? Explain briefly:
I II
C5. Growth, subsequent development, or related activitIes likely to be induced by the proposed action? Explain briefly:
I J
C6. Long tenn, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I I
C7. Other impacts (including chanQes in use of either Quantity or ty e of energy? Explain briefly:
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: I
DYes DNa I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? II yes explain:
DYes D No I . 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, 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 directly to the FUL
EAF and/or prepare a positive declaration.
CheckihlsboiIfyou-tii,ive-dete'rmTned','based-o'n"the 'information and analysis above and any supporting documentation,tha"t'theproposed 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
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)
. Board of Trustees APPlic!on
County of Suffolk
State of New York
$Y'1~~ F !fE/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 IDSIHER 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, TIIE 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,
P_~4~ ~~.
~ ~/
Signature
SWORN TO BEFORE ME THIS----itii.-DA Y OF "J II JA .Al.r-,20~
~~~
MRANle OOl\OS~
NOTARY PUBLIC, State 01' ew""l!
No, 01004634870
Qualiliedin Suffolk couni6 ~ b
cornrniSsion fxlllre~ Sep~ . ---
. .
APPLICANT/AGENTIREPRESENT ATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of SouthoJd' s Code of Ethics nrohibits conflicts of interest on the Dart of town officers and emnlovees The Dumose of
this form is to orovide information which can alert the town ofoossible conflict~ of intere~ and allow it to take whatever action is
necessarv to avoid same,
YOUR NAME: J E.; t> y :M fit E..s F.
(Last name, first name, -tpiddle initial, unless you are applying in the name of
someone else or other entity, such as a company. Ifso, indicate the other
person's or company's name.)
NAME OF APPLICATION: (Check all that apply,)
Tax grievance Building
Variance Trustee l---'
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 yOUf 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% ofthe shares.
YES --. NO v---
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 own~r 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
qt 200~
S~bmitted IhiS~_d~~
~ ~~r~a~:~~~. -
Form TS I