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Home My WebLink AboutTR-6273A James F~ King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel Town Hall 53095 Route 25 P.O. Box 1179 Southold~ New York 11971-0959 Telephone (631 / 765-1892 Fax 16311765-6641 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 st 1 dayof construction ½ constructed Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen John Holzapfel 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 Permit No.: 6273A Date of Receipt of Application: December 27, 2005 Applicant: Southold Park District SCTM#: 65-1-19.1 Project Location: 1025 Terry Lane, Southold Date of Resolution/Issuance: January 18, 2006 Date of Expiration: January 18, 2008 Reviewed by: Board of Trustees Project Description: To replace the existing chain-link fence with new stone columns with chain fence in the same place, and to place dumpster located at the nor[hwest corner of the parking lot on an 8'X 10' concrete slab and construct a 6' high stockade fence with a gate surrounding it. 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 survey received on 12/27/05 and approved on 1/18/06. Special Conditions: This permit is issued with the Condition a drywell is installed to contain the run-off from the parking 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. King, Board of Trustees James F. King, President Jill M. Doherty, Vice-President Pegg~y A. Dickerson Dave Bergen John Holzapfel 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 TO: ~:JOC~t~.O~ PO. dc ]/x~C06;c~ Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: has been and the (v/) 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: TOTAL FEES DUE: BY: James F. King, President Board of Trustees ~IIIIIJIIIIIII~I~IIIILIJL~I~J!II~IllIII,I'I; ,,/ "='-- SOUTHOLD PARK DISTRICT P.O. BOX 959 SOUTHOLD, L.l., N.Y. 11971 631-765-6019 January 10, 2006 Mr. James King, President Southold Town Trustees Town Hall, Main Road Southold, NY 11971 Dear Mr. King, Re: Founders Landing Park, Terry Lane, Soulhold The Commissioners have requested that I write to you regarding amending the pending administrative permit application that we have on file loc our Founders Landing Park. We are also proposing to p~ace the dumpsta' located at the no[th west comer of the parking lot on an 8' x 10' concm, te slab and construct a 6' high stockade fence with a gate surrounding it. (See dreW~ng on survey). Thank you for your consideration. Sincerely, Linda D. Bertani Secretary/Treasurer ,IAN 10 2006 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) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ___Coastal Erosion Permit Application __Wetland Permit Application ~,'~Administrative Penrdt Amendment/Transfer/Extension -~ece~vved Applicati~ ] ~Received Fee:S_ ~'~] ~Completed ApplicX~I~ __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: ~ate of Inspection: I/i I riot ~Receipt of CAC Repo~: __Lead Agency Determination:___ Techrdcal Review: ~'~"~ublic Hearing Held: ~ __Resolution: Name of Applicant Address Phone Number:(l,3~) ?~ h~OI C1 lq] I Suffolk County Tax Map Number: 1000- b~' - I~ Iq. ( Property Location: tOJ~' Te.cr _(provide LILCQ Pole #, distance to cross streets, anal location) AGENT: (If applicable) Address: Phone: ~rd of Trustees Applicati Land Area (in square feet): Area Zoning: Previous use of property: /'3 ark 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/cxl by a goJ~ermnental agency? ~'/ No Yes If yes, provide explanation: Project Description (use attachments if necessary): trd of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /~eff3 [o..e.~ ~,,[~ ~. ~o_, t 1, ~lc~ Area of wetlands on lot: () square feet Percent coverage of lot: 0 % Closest distance between nearest existing]structure and upland edge of wetlands:__ ] ~l z feet Closest distance between nearest proposed structure and upland edge of wetlands: '~ '~ l~ 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: Proposed slope throughout the area of operations: I"~o r~ ~ Manner in which material will be removed or deposited: feet 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 httachments if appropriate): ~ROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1 APPLICANT / SPONSOR 3.PROJECT LOCATION: Municipality 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME 4 PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc - or provide map 5. IS PROPOSED ACTION: [] New [] Expansion I~Modilication / alteration 6. DESCRIBE PROJECT BRIEFLY: SEQR 7. AMOUNT OF LAND AFFECTED: Initially ~,,~.~ acres Ultimately 2. ~ acres 8. WILL OPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~] Residential E~] Industrial E~ Commercial E~Agriculture ~k / Forest / Open Space ]Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fe~dera~....State or Local) ]Yes [~o If yes, list agency name and permit / approvak lt, DOES ANY~IY A~.~EA CT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes L_.~o If yes, list agency name and permit / approval: RES OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION'~ I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: if the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART I1 - IMPACT ASSESSMENT (To be completed by Lead Agency) 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 B 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 ar~other involved agency. 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, naise levels, existing traffic pattern, solid waste production or disposal, potential for erosion, drainage or gooding problems? Explain briefly: C2. ~,esthetic, agricultural, amhaeological, hisioric, 0~ other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. Ve§etafion or tsunal fish, sh~iifish o~ ~vildlife ~poeies, significant habitats, or threatened or endangered species? Explain bfiefly: C4. A community's existing ~lans or goals a~ officially ~dopted, or a Change in use or intensity of use of land or other natural resources? Explain briefly: C5. Grow'h, 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-C57 Explain briefly: C7' Other impac!s (including chan~s in u~ Of eithe[~uanti~/or type of energy? Explain briefly: D. W~LL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTA~BLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEAI? (If yes, explain briefly: [~Yes [~No E ~S THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: FART III - DETERMINATION OF SIGNIFICANCE (To be com¢)leted by Agency) INSTRUCTIONS: F~reachadveraee~ectidenti~edab~ve~determinewbetheritissubstanfia~arge~imp~rtant~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) 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 FULL EAF and/or prepare a positive declaration. Check this b~)x if you have ~le{e~mi~ne(~, based on ihe information and analysis above and any suppoding documentation, that the proposed actior 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) of Trustees pp lcatlon County of Suffolk State of New York Ll~o._ O. ~'~c"t"c~n: 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 HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH 1N 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), 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 CONFUNCTION WITH REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS LYNDA M BOHN NOTARY PUBLIC, State of New York NO. 01BO6020932, Suffolk Term Expires March 8, 20~' APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and emolovees. The purpose of this form is to provide information which can alert the town of possible conflicts of intem~t and allow it to take whatever action is necessary to avoid same. (Last name, first name, middle 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 allthat 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 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% of the shares. 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 Southold Title or position of that person Describe the relationship between yourself(the applicant/agenffrepmsentative) 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 shams of the corporate stock of the applic0nt (when the applicant is a corporation); ___B) the legal or beneficial owner 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 Form TS 1 Submitted this ~ '~ day of Signature ('~)3~.7. Print Name L~ ,nd..., 200 (