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Home My WebLink AboutTR-6178AAlbert 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD Permit No.: 6t78A Date of Receipt of Application: August 22, 2005 Applicant: Jeanne & Jose Castano SCTM#: 117-1-11 Project Location: 1700 Grathwohl Rd., New Suffolk Date of Resolution/Issuance: August 24, 2005 Date of Expiration: N/A Reviewed by: Board of Trustees Project Description: To trim the phragmites to 12" by hand, as necessary. Findings: The project meets afl the requirements for issuance of an Administrative Permit set forth in Chapter 97 of the Southold Town Code. The issuance of the Administrative Permit allows for the operations as indicated on the survey approved on August 24, 2005. Special Conditions: None 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. Board of Trustees ~'~ ~,~ APPROVED BY Z 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, NewYork 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 Permit Amendment/Transfer/Extension ~.-~-"Received Application: '~l~le~l ~R:eceived Fee:$ c~[,h~ _ ~mpleted Application<~[ol& __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent). __LWRP Consistency Assessment Form CAC Referral Sent: __Date of Inspection: __Receipt of CAC Report: __Lead Agency Determination:__ Technical Review: ~r~Public Hearing Held: ~>~ Resolution: Phone Number:( ) /.~.3 i - ? 3 5t -,J~' ~ /._~ Suffolk County Tax Map Number: 1000 - PropertyLocation: 1700 6rYf't"~rl/O['1 it ~ ~provide LILCO Pole #, distance to cross streets, and location) '-/738t3Cl /17. AGENT: (If applicable) Address: Phone: of Trustees Applicati¢ GENERAL DATA Land Area (in square feet): ~ 0 (9 ~ 3 ~ , Area Zoning: ere, ioususeofprope ty: tqeg,'d h Intended use ofprope~y: fe-Sff '~m~' d Prior permits/approvals for site improvements: /~ency Date JNo prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by, a governmental agency? Yes If yes, provide explanation: _ Project Description (use attachments if necessary): d' PROJECT ID NUMBER PART '1 - PROJECT INFORMATION t. APPLICANT / SPONSOR ,,,~ O ~3C..~ 3.PROJECT LOCATION: 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 County PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide map ~'"~ Modificafloo / alteration 5. IS PROPOSED ACTION: ~ New ~ Expansion 6. DESCRIBE PRO3ECT BRIEFLY: p J SEQR 7 AMOUNT OF LAND AFFECTED: ~ ''ri . ('~D'-c'/ ,:~20 ) Initially acres Ultimately acres 8, WILL PROPOSED ACTION COMPLY WITH EX[STING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If I~o, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY (DF PROJECT? (Choose as many as apply.) [~esidential r~lndustrial J-~Commercial E~Agriculture E~Park/Forest/Open Space E~Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) []Yes ~'~o yes, agen(:;y name permit approval: list and 11. DOES ANY.~__A/SPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E~]Ye$ L.~NO If yes, list agency name and permit / approval: 12. AS A RES]I'/LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ~lYes r'm/L,~ No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Spo sot 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 II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN fl NYCRR, PART 617.4? 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 another involved agency, C COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, sudace or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, )otential for erosion, drainage or flooding problems? Explain briefly: Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: C3. VegetatJoo or faunal fi~h, shellfis'h or wildlife species, significant habitats, or threatened Or endangered species? E,~plain bdefly: 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: 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-CS? Explain bdefly: C7. Other impacts (including ch~n~es 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 CRITICAL ENVIRONMENTAL AREA (CEA)? (If yes. explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE. CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes ex~lain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determinewhether 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 FULL EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding 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) ~oard of Trustees Application County of Suffolk State of New York ar c .J BEXNG DULY SWO DEPOSES ~ ~F~S THAT ~/S~ IS T~ ~PLIC~T FOR ~ ~O~ DESCmBED PE~T(S) ~ T~T ~L STATE~NTS CONT~ED ~ ~ TRm TO Tm BEST OF mS~R ~OWLEDGE ~ BELmF, A~ T~T ~L WO~ ~LL BE DO~ ~ ~ ~R SET FORTH ~ T~S ~PLICATION ~ AS MAY BE ~PRO~D BY T~ SOUTHOLD TO~ BO~ OF TRUSTEES. T~ ~PLICANT AG~ES TO HOLD T~ TO~ OF SOUTHOLD A~ T~ TO~ TRUSTEES ~ESS ~ F~E FROM ~Y ~ ~L D~AGES ~ CL~S ~S~G ~ER OR BY ~T~ OF S~ PE~T(S), IF G~TED, ~ CO~LET~G THIS ~PLICATION, I ~BY AUTHO~E T~ ~US~ES, T~IR AGENT(S) OR ~P~SENTATI~S(S), TO EN~R ONTO MY PROPERTY TO ~SPECT T~ P~MISES ~ CON~CTION ~TH ~V~W OF T~S ~PLICATION c~ Signature SWORNTO BEFORE METHIS --~- DAYOF j/~7/'~5 mary Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibJts conflicts of interest on the pan of town officers and employees. The numose of this form is to nrovide information which can alert the town &possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOURNAME: (~/~-57'7~/{,/0) ,J~'-~r/'~'/t~E ]~, (Last name, first name, middle initial, unless you are applying in tbe name of someone else or other enti~, such as a company. If so, indica~ 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 &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, nlarriage, 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/agent~mpresentative) 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 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 SubmiRed this ,23 day of ,4~'c~4' 200 ~ Signature (~ ~ tf~ ~ -- PrintName o' ,T'~/.~,vr~e ('~,~v~r?o