The URL can be used to link to this page

Home My WebLink AboutTR-5966A . . Albert J. Krupski, President James King, Vic~-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) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 5966A Date of Receipt of Application: August 5, 2004 Applicant: Joseph Friedman SCTM#: 143.5.11 Project Location: 590 Riley Ave., Mattituck Date of Resolutionllssuance: August 18, 2004 Date of Expiration: August 18, 2006 Reviewed by: Board of Trustees Project Description: To replace the existing cesspool system. 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 the Administrative Permit allows for the operations as indicated on the attached survey prepared by Anthony Lewandowski dated August 9, 1991. Special Conditions: The new system will be installed landward of the existing system and as indicated on the revised survey. 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. J,u,..(- 9- ~"'I'J.J..' t}. Albert J. Krupski, Jr., President Board of Trustees . ~r \ " ~ ~ ~ (\~~s. pOD /3 ,... ~/LEY ~ 51,", / ~ Southold 10'/10 Soard of lrustees ~7,:). 3/c-- "''''''';;''!73:0'-~- - '..,-~~ L -. · /....~.I ' ' ,---I i~l i I I b ~~,. l_~~~:" r- 1 (') Q-.w;-t"" " ~<A8 ........"....... L O'J~T ~ ~ . ~ ~" ~ ~ ~ -.-/;1110 ~..._-. r . A If.-0<c'./c- --_._.._---,..__.,--~ C, lJ'fl)l1~ ill J\I'~D\O D\.. voOll1 I'ICJ>~'T // ~qI1-01 nil-V> ~ c.G~~ <-w~ ~ .::'~y,~Y,,&:'d~ / ,h,..?&DN /Y.I EGEA1~t?-<€ ~/e.Pfr?A'.u__ ~ I T~ /Z "~.b' ", "'-t;2~__7'-~w"..,~ r:Al:4 ~Ty'"t'"-';'A!.w' ~ .(4Z.R~ M"A''',"..(~L ~&)C~.:J~' Af'A'T/7~. &.IY"V.vr,5C:>Pr>H:>'P. ~y. /' ~ ~~.l"LU~_.r'":,~.,~t1o'.!"~-:r L~.PO'~~~~-1'#~d"~~A'Ng ."';P/A'F d/'" ~c;::.9 _~~! UA'~TY C~,,"<o/.r~~~____~____ ____~ ______~ _____ ::$.1:. TA'....M'A'....-"'.../.._ - /~~ -c:>1T-// P-9T~/9~r ~/f'7/ ~qA'~"'./M_+iO/ c....v~d".7'.r ~,.,4"......n> /_~A/ TH~ . AI~.7'H,",.dy' J<< .::'<1'"KA'~.?ld~</ L~.p ~.r.>-t:U:' .;::1'~/ .</. Yo ~~L~L~L ~---------__,_._ _____ ._n - !He- .1+-01 -fl-Ol + + L "'-'trMU. E --- --i!-- G -~- ------ E -,- --...-..-..--. N 0 -. " O. ~~."'" \ . --~. _-..-..... (21) -- s..,._ c..rtrLb ....._ 12.1Aldl or12.1A 1_U. __ 12.1 Aiel .....LN -- ---- --- --SCII- .,......._u. --M-- ...... ~~ ,-~ """"" 0 - .- llIE "OLLOWIoIG IlIS'flIICTSo Fh_Ln. --F-- ~-..... -'-R-- ~ !Ul ..... - --... --1-- -- -1151__ .. . """'" --- __Ih--l__ "'" . .".. ...-- --L-- ,. " ..... ---- --- --p-- --- -n__ ...... USTnATEll ----- --- --5-- NOTICE (i) COUNTY OF SUFFOlK@ K """IF SOUTHOLD E ~w IlAltTEtWl::E,ALTERATION,SAL.EOIl Red Property Tax Service Agency y lISTRlIllITntfJ'AN'l'PORlllNCFTlE CotIltyCenter R1vlll11ecld.NY 11901 w W ..... IF SlFfW COlIITY TAX IW' IS l'AlIBTED .. SCALE N FEET, W 'IDIlllT1IITTOIPEIIIlSSlCttCFTHE .. 0 .. lit A - "'~.. 1000 IlEALPR(F'(RlYTAXSERYK:EAGENCY. P -----......- -. 1"'t'(\Jt"t.I'(IT MAt" + o -N- + '. SECTION NO 143 PROPERTY MAP IHO-9 06'lt-OI '21"01 . I' \ '--ll ."""'W -,,"" . + + L ~,":.Ih --~~ -- ---. -!Itlrti;!-!r' --SDl- W"ant-..n:tLl'lo--H__ ...... ORA'H TH~~~OW~ ",-", NOTICE . COUNTY OF SUFFOLK @ , mllf SOUTHOlD E --iZ-- --.-..... *i?1l @ --F__ --R"--,_ _. ,,- DISTRICTS. E ~ --.... -~ ..-.. --.. -- U1 "'" ~ ~Al.muTQl,SAl.EOR Red Property T ox Service Agency y G --~.. ------ -- --.. --,-- ___LI'lo -NSf__ - . ..... (JSTJIlIll.JTDl~JMtP91TDl(FTIE 122 143 122 """IF E ..............-..----, -- -.. --- .....-.. --L-- _IrII1c1L1'lo__A__ "'" . ..~ SLFfCO(COLHfYUXr.w>ISPRtHlITED Comty Center R1verf1eod,N Y 11901 W N SW-Is... ,~ " "'"'" .... SCAlENFEm 0 ....~ " -~ 12.1Aldlorl2.U'-LI'lo ---- ...-.. --,.-- ___tn_If__ -- 'ASfElAIEll IITJQlTIRTTEHPElMsSlCN~TIE III I l1li .. A ,. ..-.. 1000 -~ 12.1AIC) -.. ----- --.. --5-- REALPRlJIERTYUXSERVUAC9(:y. P PROPERTY NIP + ~ -N- + SECTION NO 143 PROPERTY MAP . . ~~.. Albert J. Krupski, I'resident 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) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only _Coastal Erosion Permit Application .....-wetland Permit Application _ Major VVaivedl\n1endrnenU e ....-Received Application: -oLReceived Fee:$ ~mpleted Application _Incomplete _SEQRA Classification: Type I_Type II_UnIisted_ _ Coordination:( date sent) CAC Referral Sent: ;li'ISate of Inspection: yjlqo( _Receipt ofCAC Report: _Lead Agency Determination:_ Technical Review: -Lublic Hearing He~ Resolution: Minor a.tll'I\trl, :l Southold Tuwn Board of Trustees ~E :G~: :o~ Address J6S'I<f)iJ u:ft{~~. <,.~;:I ~l.tl'-I A-uif ovtATr1'TLla" Name of Applicant Phone Number:( ) ;z, "l ~ <91&4 Suffolk County Tax Map Number: 1000 - . \ LI ~. ~. I' Property Location: lM. A-\.r1'fUr'IL J... &..D~ ~iltA.n+ tF t'>\1h I'l R~ - a:r= B~'1 .,4-V6YluB"' (provide LILCO Pole #, distance to cross streets, and location) AGENT: ft(4, (If applicable) Address: Phone: . . Board of Trustees Application GENERAL DATA Land Area (in square feet): Area Zoning: el~l tlL"", 11 IiL Previous use of property: . PY<:.I1'~ Intended use ofproperty:J'eJ~ Prior permits/approvals for site improvements: Agency Date _ 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: Proj ect Description (use attachments if necessary): r (,;fLU,.- e-ki "S,.,~C ~~tx:'lL vue- ill ~bd,... ~l.u2e, W\1'tt :;, l' Xt' V6Ol.S l:YC>vtl-U,ST1lfrr ~ uJV.rL>{l, 4-S ""')~n"'C; ~rP60L . . Board of Trustees Application WETLANDITRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: square feet Percent coverage oflot: % 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 y: Yes / If yes, how much material will be excavated? cubic yards cubic yards How much material will be filled? 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 of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments ifappropriate): ~CJ(\ e PROJECT ID NUMBER . I . PART 1 - PROJECT INFORMATION 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW - SI-fORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only (To be completed by Applicant or Project Sponsor) SEOR 1. APPLlCAN\! SPONSOR .JO~~1i- ~~lW-- 3.PROJECT LOCATION: 1'\\/I-Tn,-uCIC_ Municipality ":it.. n/ d-1I 110 <<A'\ 4. PRECISE LOCATION: Street Addess and Road 2. PROJECT NAME County Intersections, Prominent <;:u(?tU landmarks ete - or provide map <\46 (20 u>'-( 41.1B, (V/4-rrl1UCK 5. IS PROPOSED ACTION: 0 New 0 Expansion odification I alteration 6. DESCRIBE PROJECT BRIEFLY: ~ l2~l~C Ce8'1.-k 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8l:1J5L PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? )f:1 Yes D No If no, describe briefly: !)!!fAT IS PRESENT LAND USE IN VICINITY tJ Residential D Industrial DcommerciaJ OF PROJECT? (Choose as many as apply.) DAgriCUlture 0 Park I Forest I Open Space Dother (describe) 10. OOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL GENCY (Federal, State or Local) Yes D No If yes, list agency name and pennit I approval: r _ 1>6Upj"L~ Ib 0)(\ 11~S ~ es ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR DNa If yes. list agency name and permit I approval: ~bt<Tlfod t:udl N WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? APPROVAL? ORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE SI nature 1~~'1 Date: Applicant 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 comDleted bv Lead Aaencv) 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. D Yes ~ No 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 00 No 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, noise levels, existing traffic pattern, solid waste production or disposal. potential for erosion, drainage or flooding problems? Explain briefly: I tJO I C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly: I No I C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I No 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 110 I C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I IVo I C6. Long term, short term, cumulative, or other effects not identified In C1-cS? Explain briefly: I ~O I C7. Other Impacts (including changes in use of either quantity or type of enerav? Exolaln brieflv: I tJl) 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: I DYes I1l No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: DYes ElINO I I 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, 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 Dr more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL 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 actio WILL NOT result in any signfficant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi detennination.C' ~ .... I \ ) ~ \A'''''''''' "\ ~ &-lO -01 \ \ _ Name of Lead Agency t\e"~ T~~~\-\- Pnnt or Type Name of Responsible Officer 10 Lead Agency Date E:V'VI_~ 1 leJ..~,c"" 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 J ~"9~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 HlSIHER 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 AL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S , GRANTED. IN COMPLETING THIS APPLICATION, I HEREBY AUTHORIZE USTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO ROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH RE F THIS APPLICATION. SWORN TO BEFORE ME THIS DAY OF a~ ,20~ N PAT1IiCIA CORwlrf 0131)' PublIC, Stahl of New \'aQ NO.01C0501785Z Ca Q.uallf,ed in Suffolk CO"..... _ mmlSSlon Expires Sept j'i;" ~ - . . ..' ."4 APPLICANT/AGENTnREPRESENTATlVE TRANSACTIONAL DISCLOSURE FORM Th: T:;" sOf :::,~thold' s Code of Ethics orohibits conflicts of interest on the Dart of town officers and emnlovees. The oumose of th' fo i to vide information which can alert the town of nossible conflicts of intere!ott and allow it to take whatever action is neces..'W'V to avoid same. J .' YOUR NAME: ~ie1>~. ~J1. J. (Last name, first name, J1Iiddle 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 Variance Change of Zone Approval of plat Exemption from plat or official map Other (If "Other", name the activity.) Building Trustee Coastal Erosion Mooring Planning Do you personally (or through your company, spouse, sibling, paren~ or child) have a relationship with any officer Dr 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. X1 , 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 South old Title or position of that person Describe the relationship between yourself (the applicantlag~ntlrepresentative) and the town officer or employe~. Either check the appropriate line A) through D) and/or desctibe in the space provided. The town officer or employee or his or her spouse, sibling, paren~ or child is (check all that apply): _A) the owner of greater than S% ofthe shares of the corporate stock of the applicant (when the applicant is a corporation); . _B) the legal orbeneficial owner of any interest in a non-corporate entity (when the applicant is not a corporation); _C) an officer, director, partner, Dr employee of the applicant; or _D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I fJ'ACUS'T 200i . . 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) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental Conservation (DEe) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services County Center Riverhead, NY 11901 852-2100 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 212-264-3912 NY.S. Dept. of State Coastal Management 162 Washington Ave. Albany, NY 12231 518-474-6000