HomeMy WebLinkAboutTR-6356A
.
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.: 6356A
Date of Receipt of Application: April 24, 2006
Applicant: Thomas Nadherny
SCTM#: 70-50-34 & 35
Project Location: 1025 Pine Neck Road, Southold
Date of Resolution/Issuance: May 17, 2006
Date of Expiration: May 17, 2008
Reviewed by: Board of Trustees
Project Description: Replace the waste pipe to the existing cesspool as per survey
prepared by Anthony Lewandowski received April 24, 2006,
Findings: The project meets all the requirements for issuance of an
Administrative Permit set forth by the Board of Trustees,
Special Conditions: Native non turf plantings on the area to the west of the
stairs to avoid runoff into the wetland and creek, in line with existing
vegetation to the east.
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,
~~~
James F, King, Vice-President
Board of Trustees
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
Southold Town Board of Trustees
Field Inspection/W orksession Report
Date/Time:
r;1, of 0("
Name of Applicant:
~""bJ:)
JVttJ ~
Name of Agent:
Property Location: SCTM# & Street
70 -(, - s Y, 'j ~
,
9 If Itvt..e -5Cu1 ~S:r'-k "->
Brief Description of proposed action:
T)Jpe of area to be impacted:
~Sa1twater Wetland _Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Pqrt of Town Code proposed work falls under:
~Chapt.97 _Chapt. 37 _other
Type of Application: ~Wetland _Coastal Erosion _Amendment _Administrative
_Emergency
Info needed:
lVa
~llAr"J- ~ ""- <;+z; I 'J ,fY) Ji~ wi v'(j-/-"'-f>.-
jrMA - -+0 ("M*",~ Y\,~ i&
Modifications:
Conditions:
/ // ./
Present Were V J.King J,Doherty P,Dickerson D. Bergen J,Holzapfel
_Other: -~ t\G..~ - -
.
MailedIFaxed to: .
Date:
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180.10 No.
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Page
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DCJS-3205 (10/03)
"FALSE STATEMENTS ARE PUNISHABLE AS A CRIME, PURSUANT TO THE NEW YORK STATE PENAL LAW.
Pages
.
4682
Town 01 Southord
Sullolk County, NY
The People 01 lhe Stale 01 New York .s.
'JI'ljE(DEFe~V A'; ARSTNAME
~Il' t> en'N
T ADDRESS .
~ ~~~;;~_TI~N~
MIDDLE INmAL
m
APT. NO.
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PLATE TYPe
o N.J. ONY o N.J. 0 o PASS o COMM 0
MAKE
U'CK 0 eHev 0 CAOIl..LAC
ORO 0 OLDS 0 "-m
OYOlA 0 YOLKS 0
0 '0' 0 'OR 0 B"' 0 Mev
0 TRUCK 0 TRAILER 0 V'N 0
:BER
DATE EXPIRES
o
o
DODGE
PONTIAC
o s.W.
THE PERSON DESCRIBED ABOVE IS CHARGED AS FOlLOWS
PCT
FACTUAL PART (NOT FOR TIIB)
,. _EO OEFEN"-'NT 010 ON THE "^TIEO",TE TIME '"0 Pl.AeE ~ Afl;A1-~
~i? !~~i7 ~s, ';:~601
""-'~'~']h ~'"~'"::-~tr;t:".'d
lCHEOULED ANE $ CONTACTCOUAT 0
THe PERSON DESCRIBED ABOVE IS SUMMONED TO APPEAR AT
SOUTHOLD TOWN JUSTICE. COURT, 530M ROlin 25, SOU'I'HOLD, tlV 11871
cJ;:;Z;"~
I ~
I ^T rSIJ d
:MENT$ HEREIN ARE PU\liSHABLE AS A CLASS A MISDEMEANOR PURSUANT TO SECTION 210.4/5 OF THE P,I-N. '1.5.
,"T
~h <<r
BADGE /I
An
COURT COPY
-- ------ ._~---~.- ~---.'
.
A-4681
Town 01 Southord
Sullolk County, NY
The People of the Stale 0' New York .s.
4';ri7hY~ 7~~
71 A007,SS , &. /J
U~~:s . lV'
CI~..........nv tVv
-- UCENSE OR REGISTRATION NUMBER
MIDDlE INmAL
APT. NO.
//-#J
PLATE NO.
DATE EXPIRES
STATE
o N.Y. 0 N.J. 0 N.Y. 0 N.J. 0
PLATE lYPE
DPASS DCOMM 0
VEHICLE MAKE
o BUICK
o FORO
o TOYOTA
0 OCOGE
0 eHev 0 ""NTIAC
0 0lD$
0 VOlXS 0
0 '0' 0 B"' 0 MCY 0 s.w.
0 TlWLE' 0 V'N 0
BOOY
TVFE
VIN NUMBER
THE PERSON DESCRIBED ABOVE IS CHARGED AS FOLlOWS
n.""'Q';'J;"~':lo~ ". '"--"'--:~;'-o/..f7~'.'"'
PAAKlNGSCHEOULEDA~ CONTACT COURT 0
THE PERSON DESCRIBED A80VE IS SUMMONED TO APPEAR AT
SOUTHOI..O TOWN JUSTICE COURT, 53Oll15 ROUTE 215, SOUTHOLD, NY 11871
ON
;:M~~
.....
I AT
n~
FALSE STATEMENTS HEREIN ARE P\..JtIjjSHABLE AS A ClASS A MISDEMEANQFl PURSUANT TO SECTION 21 0.45 OF THE P.LN. V.S.
COMPLAINANT
O"'~ /?/tJP
BADGE (I
/?tr-r
COURT COpy
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
.
Town Han
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
Coastal Erosion Pennit Application
_Wetland Pennit Application ~dministrative Pennit
Amendment/Transfer/Extension
_-Received Appli~~: 'f! ~ II I Ok>
..........Received Fee:$-;)U
<-€ijrnpleted Application '-lId ljl.1l,L
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordination:( date sent)
_LWRP Consistency Assessment Form
./CAC Referral Sent:@
~ate of Inspection: t;J1O)~
_Receipt of CAC Report:
_Lead Agency Detennination:_
Technical Review:
~ublic Hearing Held: 51/ '11()~
.
_Resolution:
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
APR 2 4 2006
Name of Applicant
~..,~\
r?ne
Address / c> .1 r
/7
/f;/~y-'hV
.-/
/!/i r /( eo.d
S~~/Z1oI
Phone Number:~ 7LFI,,!,-S-2.
Suffolk County Tax Map Number: 1000-
Property Location: ~'" -1/01/. ~t.J tifk.
lIiJo 16ft' -/I"/D /50.f:f j., &nr'Jeti ~"'e
(proyide LILCO Pole #,distance to cross streets, and location)
AGENT:
(If applicable)
- /fir is /1 ~.,rt I:>
Ok r c---;r/vlt:41:::/
Address:
Phone:
411fard of Trustees APPlica~
Land Area (in square feet):
GENERAL DATA
;2 A c re.r- pr-ofertj
Area Zoning:
Previous use of property:
d.....e. rC'J//eKL.R
,
5' /t?1. e-
Intended use of property:
Prior permits/approvals for site improvements:
Agency
]) IZ-C
)~rt 1 Ar....j
TOw,", i s..~+f.<J{oI
Date
fI1Jl':{ 12.} ,qq~
M de '--c/'.L 3 J l"t q'i
M <-.j
2.G. If(qtt
,
_ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspende9- by a governmental agency?
~No_ Yes
If yes, provide explanation:
Project Description (use attachments ifnecessary): Yj q ~ 1..Ni ste
jJrtC- -J, t'c?f~,/ .f r~ ~4e;4'.
4IJoard of Trustees APPlica1llP
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: 1)/" LJ),{}", ~ c-esrr~/
hit! iN)! COd /'u{ b f ~t?f~ ~,.ely ''''J-IrL~II'J
? Ifj .j;;>.- -k C.#'ff. I I~iv bd\-s'eYl<e..t.tJIJ
tJa.Jfe rli'e (or-a'lf,JeblA-:J r" 17/ net" ~ lqo~a-d'.
Area of wetlands on 101:- .r-;t. 9'00 square feet
Percent coverage oflot: - ~- 7.., %
Closest distance between nearest existing structure and upland
edge of wetlands: ,,, D feet
Closest distance between nearest proposed structure and upland
edge of wetlands: feet
Does the project involve excavation or filling?
No /' Yes
If yes, how much material will be excavated? 3 cubic yards
How much material will be filled? t"{i..J~ It .stu6~~o?c yards
Depth of which material will be removed or deposited: .2-3 feet
Proposed slope throughout the area of operations:
/V'/-I
Manner in which material will be removed or deposited:
4J I' / / ~e
- 5..c.hA r-
~;f
b ~ tr- ~
rJ/'d/~/
eXC4 VJ -I v~
as
are 4..- t../1!14
k tic?
:h.,)
,
Municipality
LOCATION:
S;t)<<-li~ 1/
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
.
PROJECT 10 NUMBER
SEQR
PART 1 - PROJECT INFORMATION
,. APPLICANT I SPONSOR
o/YJ4S
re tI:.<'
3.PROJECT
County
~ /h//(
4. PRECISE LOCATION' Street Addess and Road Intersections, Prominent landmarks atc - or orovide map
o.)...{ /ne
5 IS PROPOSED ACTION'
,A/{h k
o New
/2a/
- .Ih kr.ll!'n/...
~../-~/-
D Expansion
~odification I alteration
6 DESCRIBE PROJECT BRIEFLY:
Cl'f~o! 111e> i;u'; k.eL w-r /;,~ h,S" IIttJ"J
c.rMIf"q' ~J11 C7~ l~/ 1:J_~o--ls 6J~/~t'
41<e n IP,,-.J a-A. J'1~M /.1//-:/ /k.-I //}.
d~ ~ ~,-t 6/','.e
"ee~ ~ dt'
7 AMOUNT OF LAND AFFECTED: .J-O-
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WlTH EXISTING ZONING OR OTHER RESTRICTIONS?
~s D No If no, describe briefly:
~~T IS PRESENT LAND USE IN VICINITY
L!:d'Residential 0 Industrial o Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture D Park I Forest I Open Space
DOther (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
wx-es D No If yes, list agency name and permit I approval:
6-f ~,,-I-JDIJ7.
1,. DOES A~ECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR
DYes ~o If yes, list agency name and permit I approval:
APPROVAL?
12. AS A ~ OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
[]yes L:1No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
~,;> I SPO'7 pame DateAfJ J-.o~".
Signature ~~ ~
If the action Is ostal Area, and you are a state agency.
complete the Coastal Assessment Form before proceeding with this assessment
.
.
PART II - IMPACT ASSESSMENT (To be completed bv Lead Aoencvl
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.
DYes DNo
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.
DYes DNO
C. COULD ACTION 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: l
I
CZ. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
,- . . ... . ..
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:
L-- I
C5 Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
I - I
C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I ... .. . . I
C7. Other imoacts (including channes in use of either Quantitv or tvne of enemy? Explain brieflv:
I.... I
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: 1
DYes 0 No I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
DYes ONo I I
-
PART 11I- 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 adverseimpaGts 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.
-- ____ ____u_______ __________
Check this box-if you have -determIned, basec!"on the lnformation and analysis above and any supporting documentation, that the 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
Pont 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 Application
County of Suffolk
State of New York
/k;f,l u." BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HEI 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 IN 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 CONJUNCTION WITH REVIEW OF THIS APPLICATION.
J~ign~
SWORN TO BEFORE ME THIS dL(
DAYOF-8frl \
_,20 -D....o
~r~( )c
Notary Ptiblic _________
PATRlClA WARNER
"'*'Y f'ublic,.~1I of New 1lllI
n..J1R.OlwA6140448
_",eel in SIlffoIk Cc!!Jpty
Commission Expirn January 30~n\ l f")
.
.
APPLICANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics orohibits conflicts of interest on the oart of town officers and emnlovees. The Durnase of
this form is to nrovide information which can alert the town of nos sible conflicts of interest and allow it to take whatever action is
nece!'\Sarv to avoid same.
)t~ VJe r f1 t) ,I1l ,4-J
(Last name, first n e, .tpiddle initial, unless y u are applying in the name of
someone else or other entity, such as a company. If sa, indicate the other
person's or company's name.)
YOUR NAME:
NAME OF APPLICATION: (Check all that apply.)
Tax grievance
Variance
Change of Zone
Approval of plat
Exemption from plat or official map
Other
(If "Other", narne the activity.)
Building
Trustee
Coastal Erosion
Mooring
Planning
~r"'Jj,d Uf.t{h>',)/'i'e.
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 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 /
r~ plHe-
If you ansv.'ered "YES", complete the balance of this form and date and sign where indicated.
Name of person employed by the Town of South old
Title Of 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% oCthe shares of the corporate stock of the applic;;s.ot
(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
Submitted this _day of
Signature
Print Name
200
Form TS I
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