HomeMy WebLinkAboutTR-6255A
Albert J, Krupski, preside. i . 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) 765-1366
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
- y" constructed
t/ Project complete, compliance inspection.
. .
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. Dickerson Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 6255A
Date of Receipt of Application: December 12, 2005
Applicant: William Stanton
SCTM#: 123-3-15
Project Location: 1115 Bungalow Lane, Mattituck
Date of Resolution/Issuance: December 21,2005
Date of Expiration: December 21,2007
Reviewed by: Trustee James King
Project Description: To install a 29'X 19' patio of brick pavers in sand with a 9"-
11" retaining wall, and remove the cement steps leading to the basement and
replace them with the same inter-locking cement blocks used in the retaining wall.
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 an Administrative Permit allows for the operations as indicated on the
plan prepared by William Stanton received on December 12, 2005.
Special Conditions: This permit is issued with the Condition that the area within
5'-10'landward of the edge of wetlands is a "no-mow" area. This project requires
a final inspection.
If the proposed activities do not meet the requirements for issuance of an
Administrative Permit set forth in Chapter 97 of the Southold Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
~'.f2: ~.~
Albert J. Krups I, Jr., Presl en . . .
Board of Trustees
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/ 'APPLICANT
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" \/\/ILL\AM STAN rON
/. 4- JEFFERSON 5T
W HEMPSTEAD, N'{ 11552
( 1115 BUNGALOW LA,
FREPARED Eoy MATTliUCKj {'.JYJ
COSTELLO MARII'JE CONiRACilNG CORP NOV 29,2003
FO BOY, 212+ GREENFORT, NY 11'344-
((O'6!) 477-113':)
SHEET 2 OF 4-
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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. Dickerson Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_ Coastal Erosion Pennit Application
_ Wetland Pennit Application :;;:;"'Administrative Pennit
Amendment/Transfer/Extension
--1l.eceived Application: / ~J I J./ 0 '(
.....Received Fee:$ :JD '
---.e€ompleted Application I J-II ;; I 0)
_Incomplete
_SEQRA Classification: Or.0 1 " "roc.
Type I_Type II_Unlisted L\_i L LL:UJ
-
_ Coordination:( date sent)
~ Consistency Assessment Form 1"\\"'- -
~C Referral Sent: of
-L:::Date of Inspection: Id-Il<.j\c\
_Receipt ofCAC Report:
_Lead Agency Determination:_
Technical Review:
...,d'nblic Hearing Held:~,:) \ 10'\
- Resolution:
Name of Applicant W;/I,'O,Wl E. S~r1
Address 11ft) 8u n 3M ow 1 Ct VIe Mo.JLh.dL
Phone Number:( ) 298- ~?4~ .::110 -1{~b-5~
Suffolk County Tax Map Number: 1000- I d- ? . ~-I~
Property Location: 1I1~ l3uVl~Q.Ww La.VIt M(J.Jf"~IiCk.
_(provide LlLCO Pole #,distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
411rrd of Trustees APPlicat~
GENERAL DATA
Land Area (in square feet):~ruy ~ 5..... ..tf 00 St. .p, C~~-e ,,*"Ck.<'/ $"r,,"'i>
Area Zoning: fee;; dtN\h~1
, \
Previous use of property: rt>s,rl.e.-...-nA..\
.
Intended use of property: 'l''' s i dfuftCl. \
Prior permits/approvals for site improvements:
i\gency , ~e V'l.-b /0 1
lru.sfe<es we.HCl.Ai\~ (3)'€1:~' cL,c~
-$-- No prior permits/approvals for site improvements,
Has any permit/approval ever been revoked or suspended by a governmental agency?
~ No Yes
-
If yes, provide explanation:
Project Description (use attachments if necessary): 1 IAli $h to \Qv\?1 +bL--
~nf\JV\cA f.,r 0.. 2.q'x IOj' po..+~() "f_br~c\o<. pll-\re<rS in So.Y\.d Wl~
0. q ~ 1\ "1'\(:.1-. fs+o.;V\iVlI) \).\0..1\. I 0.\50 Ul;~h +.. 'feW\(1\/C br6 \tel">
CeVvle\l\\ S-ter le~,l,I;"~+O bo.~WLeV\+ M'\J. npltA.ee ~ wi<<. ~
Sll..Y.\.e in-tef\ockil">~ ee.IMQ.~\ock~ USl>.l.'V\ fu V"e+dil'\~3 wo..!1
C~e-e MtuCheel ~t-.l'e+)
tlrrd of Trustees APPlicati~
,
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: f.o ~~s~ll 0.. PIV-t.O crf 6n~k.
~'" vetS SI!/t ;(\ $~
Area of wetlands on lot: square feet
Percent coverage of lot: %
Closest distance between nearest existing structure and upland
edge of wetlands: feet
Closest distance between nearest proposed structure and upland
edge of wetlands: feet
Does the project involve excavation or filling?
No "'/. Yes
I ';jo.,A<7f' \f"~
If yes, how much material will be excavated? cubic yards
How much material will be filled? I ';\o.m D'{ \e..s cubic yards
,
Depth of which material will be removed or deposited: ~ -1$\W\c'oIfS feet'
Proposed slope throughout the area of operations: Ic"e\ - o.
Manner in which material will be removed or deposited: 5~vel 0..",6 'l'o.\<e
Statement of the effect, if any, on the wetlandsan~tidal waters of the town that may result by
reason of such proposed operations (use attachments if appropriate):
.
I'T'-\~ In\oJ ,~ ~"'l
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 2, PROJECT NAME
Wi Iftl1YYI 'E. Stt1.Vl+vn Br:",...... t'o....~c)
3.PROJECT LOCATION:
.
Municipality County s..,
4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete - or provide map
III,? 6un.1o.~ L"""", W\.....lr t ;~u e1e..
5. IS PROPOSED ACTION: D New D Expansion ~ Modification / alteration
6. DESCRIBE PROJECT BRIEFLY:
1 w;'!>\o> t-. level~.t ~~~d ~ ~ ~q' x1Q' pa:I"i,o ...f bYl'ck. p"'^''eXs 1CA....( ''''
~",-",d)wi+{,,/4.. C)-I! Incl-> t'e.t-all'l'V'lJ WA-ll "tlM{-e..r!.och. ee..~hlocks.
! 0.\50 "j'Sh -h (e\^MI\J-e. b'fOh" C~rIl" Sf"'P5 1>411ltG.\\.3 -b base~. CI.~J.
fC?\o.C'e +~e.'f() UJ;{..~ -fkoe 8o.W\.Q. ,,,+u\t>clr-;'^3 c.el!\'l.0'i\t blocks 1A-s-ed. IV)
-+he. ret Q~V\t"j Wetl\. C~e'e o-ftach.RtI. S\t.n<:l' )
7. AMOUNT OF LAND AFFECTED: "-('f"Y 4~ S~'f+ ~'l"'J~': -45'11<5$ C>(..",iJ,.nnrn4~1<'s-h
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
0ves o No If no, describe briefly:
9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply,)
5Q Residential o Industrial o Commercial DAgricu,ture 0 Park / Forest I Open Space D Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
6{]Yes ONO If yes, list agency name and permit I approval:
11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
DYes [ENO If yes, list agency name and permit / approval:
12. AS A R ULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
Ges No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE ~
Applicant ~ Date:D<. I');
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 ITo be completed bv Lead A!lencvl
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 DNO
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 DNO
C. COULD ACilON RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, jf 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 I
CS. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
I ~ ~'^
C6. Long term, short term, cumulative, or other effects not identified in C1~CS? Explain briefly:
I I
C7. Other impacts (including chanaes in use of either Quantity or type of enerqy? Explain briefly:
I .1
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA (CEA)? (If yes, explain briefly: I
DYes 0 No I E. ID~:sE, 00 ~~ErE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes eXPlain.]
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, thedetermination 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.
Check ihis box-rr you havedetermlnecf based .on -the lnformation and - analysis above and any supporting documentation, 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
Print or I ype 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)
4Itoard of Trustees APPlicat~n
County of Suffolk
State of New York
Will, a YY\ f "Sin V)~ 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 HISIHER 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 SOUTH OLD 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 COMPLET~
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) 0
REPRESENTATlVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE .
PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION.
W~f. ~~
Signature
SWORN TO BEFORE ME THIS-1.:r t{. DAYOFdec..unber' ,20D{"
11~~~
Notary Pu he
MELANIE OOROSKl
NOTARY PUBLIC, State of New 'rbrk
No, 01004634870
, Qualified in Suffolk cauntt
CommiSSIon Expires September O. aQpb
. .
APPLICANT/AGENTIREPRESENT ATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town ofSouthold's Code of Ethics nrohibits conflicts of interest on the Dart of town officers and emolovees. The DUfDOse of
this form is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: .$tO-VI t6V'\ W; II; o..\'Y) E. ,
(Last name, first name,1piddle initial. unless you 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
(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 South old? "Relationship" includes by blood, marriage, or business interest "Business interesC 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 'f...
--- I
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 applic<,int
(when the applicant is a corporation);
_B) the legal or 'beneficial own~ 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
S~bmittedt~ D"C~
SIgnature t:.,
Print Name I I a. e, '::)h..
FOnTI TS I -