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Home My WebLink AboutTR-6243Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 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 1 st day of construction ½ constructed Project complete, compliance inspection. Board Of $outhold 'Town Trustees SOUTHOLD, NEW YORK P[:RMIT NO ................. DALE: ~.°.~.~[..?:.~z.2°°5 SUSA~I BEGKER ISSUED 10 ..................................................................................................................................... Pursuant fo f~ provisions of Cflapfer 615 of ~e ~ws of the Sfa~ of New York, 1893~ and ~apfer ~ of the ~ws of ~he - state of New Yor[ 1952: and the Soulhold To~n Ordinance f~led ?RE~U~TIN~ AND ~E P~ClNG OF OBSTRUC~HS IN AND ON TOWN WATERS AND PUBLIC ~NDS and-t~ REMOVAL OF SAND, G~VEL-OR OTHER MATERIALS.F~OM ~NDS .UNDER TOWN WA~RSi[.t. and in accmdan~ wlf~ 'fha ResoJ~ion of The B~rd adopted afa meeting held on .... ~.g.~.~ and in consideration of the sum of $..~0....~9 ..... paid by Susa~ ~ecker of gecoa~c ........................ N. Y. and subject fo the Te~s and ~ndilions listed on the revere side ~r~f, ~e:z~ ~uihold Town Tr~ees aufh~rlzes a~d permJh the follo~ng: d e:m~L :o co~st:uct a 4 ~ 60 ~xe~ ~ock ~th a 4~[de access ~a:h and 4~ ~ 9~ sLa~:s a: '~he sea~a~& end. The dock ex~e~d [~:o ~he ~a:e: apg~o~ 25~ ~:om :he edge of ~he marsh :no g~ea~e: :hah 6~ p~Z~gs; ~he doc~ and boa~ ~[Z no: ~end. a~' in accordance with the defai~d sp~EIcahons as pre.riled m · ~e ~glnafing app~fi~, as dep~c:ed on :he plan p~ega:ed IN WITNESS WHEREOF, ~e said Board 0f Trustees ~re- su~%ed by a'mal~ of fha sa~d ~rd as of ibis - · T~ees TERIvlS and CONDITIONS That this Pe,m~ should be ~l~cl indefmkely, or ~s loag ~ th~ said p,~-mttte~ wtsh~s ,,,~i~ the structure o~ project involved, to provide evidence m 4. Tl~t the wod~ lavolved will be mbject to the ia.Tectlon ~d at, pt~l ~[ d~ ~ et ks agents, tnd non-<xxnl,lt,,~e with the ptovidon~ of ~ od~,,~ttng application, maybe ~_~ [o~ g~ocafion of chis pee~e by t~solutloa of the said Board. Ul, O,x d~e ~otlce, to t~,~ve ot dte~ _~, wo~ or p~oiec~ bemh ~,__~d_ ~ith0ut eZl~aSeS to the '~a~' Ii. That the satd Boaxd will be notiflod by che Permlttee ot dxz ~anpiedoni6f the wo~ ruth. 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 November 16, 2005 Susan Becker P.O. Box 289 Peconic, NY 11958 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD RE: 4883 WELLS ROAD, PECONIC SCTM# 86-1-9.6 Dear Ms. Becker: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, November 16, 2005 regarding the above matter: WHEREAS, SUSAN BECKER applied to the Southold Town Trustees for a permit under the provisions of Chapter 97 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated October 25, 2005, and WHEREAS, said application was referred to the Southold Town Conservation Advisory Council for their findings and recommendations, and, WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on November 16, 2005 at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the proposal complies with the standards set forth in Chapter 97 of the Seuthold Town Code, WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, RESOLVED, that the Board of Trustees approve the application of SUSAN BECKER to construct a 4' x 60' fixed dock with a 4' wide access pathway and 4'x 9' stairs at the seaward end. The dock will extend into the water approx. 25 ¼' from the edge of the marsh with no greater than 6" pilings; the dock and boat will not extend more than 1/3 across the lateral distance of the creek, and all as depicted on the plan prepared by Sea Level Mapping dated 5-22-01. Permit to construct and complete project will expire two years from the date the permit is signed. Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of $50.00 per inspection. (See attached schedule.) This is not a determination from any other agency. Fees: $50.00 Very Truly Yours, Albert J. Krupski, Jr. President, Board of Trustees AJK/hkc 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 Please be advised that your application dated reviewed by this Board at the regular meeting of following action was taken: ( t,//) Application Approved (see below) Application Denied (see below) (__) Application Tabled (see below) ILO I,~S/o¢, has been il / 16/o~ andthe 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 fodh in the instruction sheet. The following fee must be paid within 90 days or re-application fees will be necessary. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE: SIGNED: PRESIDENT, BOARD OF TRUSTEES Telephone (631) 765-1892 Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 CONSERVATION ADVISORY COUNCIL TOWN OF SOUTHOLD At the meeting of the Southold Town Conservation Advisory Council held Wed., November 9, 2005, the following recommendation was made: Moved by Tom Schlichter, seconded by Don Wilder, it was RESOLVED to recommend to, the Southold Town Board of Trustees APPROVAL WITH A CONDITION of the Wetland Permit application of SUSAN BECKER to construct a 4'X 60' fixed dock with a 4' wide access pathway and 4'X 9' stairs at the seaward end. The dock will extend into the water approx. 29' from the edge of the marsh with no greater than 6" pilings. The docking facility and. boat will not extend more than 1/3 across the lateral distance of the creek. Located: 4883 Wells Rd., Peconic. SCTM#86-1-9.6 The CAC recommends Approval of the application with the Condition the docking facility doesn't exceed 1/3 across the width of the creek and there is clearing for the path only. Vote of Council: Ayes: All Motion Carried PLANNING BOARD MEMBERS JERILYN B. WOODHOUSE Chair WILLLtdVI J. CREMERS KENNETH L. EDWARDS MARTIN H. SIDOR GEORGE D. SOLOMON PLANNING BOARD OFFICE TOWN OF SOUTHOLD To: Town of Southold Board of Trustees ~ From: Mark Terry, Senior Environmental Planner LWRP Coordinator MAILING ADDRESS: P.O. Box 1179 Southold, NY 11971 OFFICE LOCATION: Town Hall Annex 54375 State Route 25 (cor. Main R& & Youngs Ave.) Southold, NY Telephone: 631 765-1938 Fax: 631 765-3136 Date: November 7, 2005 Re: Request for Wetland Permit for Susan Becker SCTM#86-1-9.6 SUSAN BECKER requests a Wetland Permit to construct a 4'X 60' fixed dock with a 4' wide access pathway and 4'X 9' stairs at the seaward end. The dock will extend into the water approx. 29' from the edge of the marsh with no greater than 6" pilings. The docking facility and boat will not extend more than 1/3 across the lateral distance of the creek. Located: 4883 Wells Rd., Peconic. SCTM#86-1-9.6 The proposed action has been reviewed to Chapter 95, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is generally CONSISTENT with the Policy Standards and therefore is CONSISTENT with the LWRP provided that: 1. No CCA is used in the construction of the dock facility. 2. The dock will be no wider that 3' to minimize wetland coverage unless a necessity for a wider dock is shown. Pursuant to Chapter 95, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Please contact me at (631) 765-1938 if you have any questions regarding the above. Albert J. Krupski, President James King, Vice-President A~ie 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 Coastal Erosion Permit Application /Wetland Permit Application Amendment/Trans fer/Ex~ten~on -.4Ceceived Application: .~eceived Fee:$~'~X..W* ~mpleted Application ~__~complete __SEQRA Classification: Type 1 Type II Unlisted Coordination:(date sent). --~"~WRP Consistency Assessment Form ~AC Referral Sent: ~ate of Inspection: ] I ] ~] I0~- _ __Receipt of CAC Report! __Lead Agency Determination:__ Technical Review: ~_A~ublic Hearing Held: 1! __Resolution: Office Use Only Administrative Permit OCT 2 5 2005 NameofApplicant ~_50_..f} ~'f_~ ( Address ~.0. 8~J i ~/ ~C ~ { Phone Number:( Suffolk County Tax Map Number: 1000 - Property Location: 4~3~ ~/~', ~J~l (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: ~'Phone: Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: Previous use of property:_ Intended use of property: I Prior permits/approvals for site improvements: Agency Date ___ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspend/ed by a governmental agency? V' No Yes If yes, provide explanation: Project Description (use attachments if necessary): Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area orwetlands on lot: ft-?,pru:,X ~O2D~square feet Percent coverage of lot: -7 · 6, % Closest distance between nearest existing structure and upland edge of wetlands: /L) /~1 feet Closest distmace between nearest proposed structure and upland edge of wetlands: -C) - feet Does the project involve excavation or filling? No / Yes If yes, how much material will be excavated? -~f~"- cubic yards How much material will be filled? -- O - 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 otqh~ ~ffect¥ff ah),, 0nth~ wetland§ andtidaq Wat~erS 6fthe town thaf maY reSUlfby reason of such proposed operations (use attachments if appropriate): NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES~ TOWN OF SOUTHOLD In the matter of applicant: YOU .ARE HEREBY GIVEN NOTICE: l. SCTM# ~'6- /- q' b That it is the intention of the undersigned to request a Permit from the Board of Trustees to: That the property which is the subject of EnvirorLmental Review is located adjacent to your property and is described as follows: 3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or 97 of the Town Code is open to public comment on: ~0 Y'. [ tro -L~ ~O~. You may contact the Trustees Office at 765-1892 or in writing. The above-referenced proposal is under review of the Board of Trustees of the Town of Southold and does not reference any other agency that might have to review same proposal. Enc: Copy of sketch or plan showing proposal for your convenience. PROJECT ID NUMBER PART 1 - PROJECT INFORMATION I,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 County 4 PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks etc -or provide map SEQR 5.1S PROPOSED ACTION: ~ New F~E×pansion E"~Modiflcation/alteration 6. DESCRIBE PROJECT BRIEFLY: 7 AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED 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~lndustrial F~CommercJal [~Agriculture F'--] Park / Forest / Open Space [~]Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL !AGENCY (Federal, State or Local) ~Yes b~No If yes, list agency name and permit / approval: 11 DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~.~Yes i--]No If yes, list agenpy name and permit / approval: 12.[~]Yes~AS R SULTNo 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 / Sport or Name Date: 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 A~lenc¥) 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. J-~J Yes j~JNo 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. 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, potential for erosion, drainage or flooding problems? Explain briefly: Aes e lC, ag cultur rchaeolog~cal hmtonc, or other natural or cultural resources or commundy or neighborhood character? Explain briefly C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain 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: CO. Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7~ Other impacts (includin~q changes in use of either 9uantit~ or type of energy? Explain bdefl¥: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAt? /If yes, explain bdefl¥: J~Yes J'--J No ..... E. IS THERE, OR iS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If },es explain: I--1 No ...... 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); (bi probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (ti 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 environmeatal characteristics of the CEA. Check this box if you have identified one or mom potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Cfieck this box if you bave determinedl based on the information and analysis above and any supporfing ~ocumentafionl that the proposed acfior 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 Title of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer ia Lead Agency Signature of Preparer (If different from responsible officer) PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: : l cO, lO Lt.-C. ~E) r o raj t ~c, ~I Address: STATE OF NEW YORK COUNTY OF SUFFOLK Office at %~J~gLIsL'~I)J~71 (certified) (registered) mail. ~U~Sa rl ~ ~.~ 1,~ , residing at /~ O. ~1~0 ~' L~Sq ~P~" D n I('; lq \] I 1(1.5~ , being d__uly sworn, deposes aild says tha~on the b~,h"-~ day of ' ~)C.alh9 b~';, 20 O<~ deponent mailed a true copy of the Notice set forth, in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite there respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post · that said Notices were mailed to each of said persons by Sworn to before me this ~x'~ Day of~, 20~-~ Notary Public Albert J. Krupski, President James King, Vice-President Artie Foster Ken Poliwoda Pegg~ A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-~(~1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD In the Matter of the Application of ....................... COUNTY OF SUFFOLK) STATE OF NEW YORK) AFFDAVIT OF POSTING I, ~,~," ' ' ' residing at ~ '5 ;~-~ k~Z~ ,¢- being duly sw~m3., depose and say: That on the~l~day of ~ ~d"J, , 2~00~, I personally posted the property known as by placing the Board of Trustees official poster where it can easily be seen, and that I have checked to be sure the poster has remained in place for eight days prior to the date of the public hearing. Date of hearing noted thereon to be held I~ {,~¥ ii, , 2~.-'~ ~7~ Dated: S~vom to before me this /~ day of//2/dlJ 200 5' Notary Public~'~ ignature) '~" Board of Trustees Application County of Suffolk State of New York ~_ ./'LS_ rl-xq _~e"rl ~ f'- 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 WlLL 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), 117 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. SWORN TO BEFORE ME THIS Board of Trustees Appli~ion ~~ AUTHORIZATION (~r~nt o~er of property)_ ~mailing address) to apply for pe~it(s) f~ Southold Board of Town Trustees on ~ behalf. (Owner's signature) Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non~ suooortine facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME The Application has been submitted to (check appropriate response): TownBoard ~ Planning Board ~ Building Dept. ~ Board ofTrusteesX~ Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital ~-] construction, planning activity, agency regulation, land transaction) ~ (b) Financial assistance (e,g, grant, loan, subsidy) (c) Permit, approval, license, certification: Nature and extent of action: Location of action: Site acreage: Present land use: '~C~. Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: ¥ (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly tmdertaken, require funding, or approval by a state or federal agency? Yes [~ No'X~ If yes, which state or federal agency?_ C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [] ,No [] Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria ~-] Yes ~ No: Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria ~ Yes [] No ~ Not Applicable . At,ach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III - Policies Pages 8 through 16 for evaluation criteria F~ Yes ~-~ No F-~ Not Ap licable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southoid. See LWRP Section III - Policies Pages 16 through 21 for evaluation criteria Yes [] No I'Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No Not~plicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. ~ Yes ~ No ~_ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. [] Yes [--] No ~ Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [] Ye~, No [] Not Applicable Attach additional sheets if necessary WORKING COAST POLI~S Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [] Y~ [] No ~ Not A_ppliFa~ble Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. [] Yes ~-] No~ Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. Yes ? No [] Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~'] No ¢ Not Apphcable-- PREPARED BY~ _~~~ TITLE ------ DATE APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the hart of town officers and emolovces. The purpose of this form is to vrovide information which can alert the town oft~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first name, Middle initial, unless you am applying in the name of someone else or other entity, such as a company. If so, indieale 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 (lf"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 thc Town of Southold? '~Relationship" includes by blood, toarringe, or business interest. "Business interest" means a business, including a pannership, 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 ~ lfyou 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 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~/Srhay of , 200 Print Nam~ ~'//~.<. ~ /~:~f/<J_ ,~ ~DEC'PERMI? ~UMBER 1-~-Ozs~g/ooom ~AC LITY/PRO~RAM WUMBER(g) NEW YORK STATE DEPARTMENT OF ENVIRONMENTAL CDNSERVAT[DN PERMIT Under the Envf rewrite{ Conservation Law EFFECTIVE DATE June 20r.,2001 EXPIRATION DATE(g) June 30, 2006 TYPE OF PERMIT · New L3 Renewa[ L-J Modification g Permit to Construct L~ Permit to Operate Jl · Article 15~ Title 5: Protection · 6NYCRR 608: Water Quality E] Article 27, Title 7; 6MYCRR of Waters Certification 360: gelid Waste Manage~nt ~3 Article 15, Title 15: Water n Article 17, Titles 7, 8: gPDEg [] Article 27, Title 9; 6MYCRR ~ Article 15, Title 15: Water Control ~ Article 34: Coastal Erosion Transport Management E] Article 2~, Title g Article 15, Title 15: Lo~ Land Rec[e~tion ~ ArticJe ~6: F[o~p[ain lsiand We[is M~negement ~ Article 24: Freshwater Wallets g Article 15, Title 27: Wi[d, ~ Articles 1, ~, 17, 19, 27, ~7; PERH[T ~SSUED TO J TELEPHONE susan Becker ., ADDRESS OF PERMZTTEE 298 gridgeport Avenuef Medford~ NY ,,.,,,1!763 Proper-T Services, P.O. Box 617, Cutchogue~ NY Backer propertyr Wells Roadf Pecanic . , LOCATION OF PROJECT/FACILITY COUNTY TOWN Suffolk SouthoLd DESCRIPTION OF AUTHORIZED ACTR/ITY: 11935 ITELEPHOHE HUMBER Richmond Creek NYTM CO0~O]NATES Construction of a single family dwelling with garage, decks, porGh, pool. septic system and asphalt driveway. The project also includes construction of a 4' x 60' dock with a 4' wide access, s~j~athway end 4' x 9' stairs at the seaward end AIl work is to be done in accordance By acceptance of this permit, the permfttee agrees that the permit is contingent upon strict con~3Lience with the ECL, at[ applicable regular[ors, the nenerat conditions specified (see PaRe 2 & 3) at~ any Special Conditions included as part of this permit, PERMIT ADMINISTRATOR: ADDRESS Roger Evans (gVA) aids. ~0{ SUNY~ S~pn¥,,Brook~ NY 11~0-~356 JHne 2or 2o01 Page 1 of 4 To~n:. Soubholdi SuFfolk Count~j N'K Put'pose, Pr'ivote l"lo, or'in~] Tid~ F~on~: 2' +/- N SEA LEVEL MAPPING CROSS SECTION Applioont: ~uson L. E~eck~r Proposed: ~olk ~ ~teps ~i[;uote: Pe¢oni¢ Th~ouc~h Oentenlin~ ~cole: I" = lO' ~ooP-. To~n: Southold Suffolk Gounf. Lj, ~:1 Purpose: Private h-loorinc Datum: Io~' wotei Tide F~oncje: 2' +/- Uplond or Adjocenb Area SEA LEVEL MAPPING ~ EAST ~IAIN STREET (4' x 609 (4 ×~ ) (4'x ~') Adjoinin9 Owners: Tax # 1000-8¢-I*q.3 Land of Pe¢onic Lond Trust PO Box 2088 Tax # 1000-86-1-~.5 Load o¢ Peoonio Land Trust PO Box 2088 $outhompto~, NY Hq&q shoreline 3¸3 existinc30ottom elevations os TEST HOLE EL=lO.5' 0.0' LOAM .3,0' SAND & GRAVEL £L= 0.$' 10.0' G,W. SAND & GRAVEL 12.0' FEB - ~ 2OOO TOWN OF S U S 34'55'31" E,_ 55.35 ~ ~ 190.20' N 34'55'31" 55.35' Lot 3 ,,' I Lot 2 _ go ~LL J (Wcont) / *;'A TTERED '" ' /" W ...60' N 4.1'50'24" RICHMOND CREEK TEST HOLE Lot 1 (Vacant) SECTION SEWAGE DISPOSAL SYSTEM NOTE AREA = 2.4087 ACRES · SUBOIVISION MAP FILED IN THE OFFICE OF THE CLERK OF SUFFOLK COUNTY ON MAY 18. 1999 AS MAP NO. 10282 · VERTICAL DATUM = N,G.V. DATUM (bI,S.L. 1929) · ELEVATIONS SHOWN HEREON MAY BE FROM MAPS OR SURVEYS PREPARED BY US AND ARE SUBJECT TO FIELD VERIFICATION. Young & Young, Land Surveyors 400 Ostrander Areolae, Riverlzeao~ New York l lgOl 516-727-2303 Alden W. Young, P.E. & L.S. (1908-1994) Howard W. Young, L~d S~eyor T~ C. Wotpert, Professional E~gi~ee~ Joh~ Ech~u~, Land Su~eyor HEALTH DEPARTMENT USE SURVEYOR'S CERTIFICATION · WE HEREBY CERTIFY TO PHILIP W. ALBRIGHT & FIDELITY NATIONAL TITLE INSURANCE COMPANY THAT THiS SURVEY WAS PREPARED tN ACCORDANCE WITH THE CODE OF PRACTICE FOR LAND SURVEYS ADOPTED BY THE NEW YORK STATE ASSOCIATION OF PROFESSIONAL LAND ~iC~SURVEYORS, ~ SURVEY FOR ~ PHILIP W. ALBRIGHT LOT 3 "RICHMOND CREEl< FARMS, SECTION 2" At Peconic, Town of Southold Suffolk County, New York County Tax Mop District 1000 S,ct;o~ 86 ~,o~ O1 Lot 9,6 BUILDING PERMIT SURVEY MAP PREPARED JAN. 15, 2000 SCALE l" =100' JOB NO. 99-0822 1 OF I DWG. NO, 990822