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Home My WebLink AboutTR-6467A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0451C Date: July 20, 2009 THIS CERTIFIES that the installation of native plants landward of the concrete bulkhead to provide a vegetative buffer At 1295 Robinson Lane, Peconie, New York Suffolk County Tax Map # 98-5-2, 3 & 4 Conforms to the applications for a Trustees Permit heretofore filed in this office Dated 10/2/06 pursuant to which Trustees Administrative Permit # 6467A Dated 10/18/08 was Issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of native plants landward of the concrete bulkhead to provide a vegetative buffer The certificate is issued to AL SAFER owner of the aforesaid property. Authorized Signature James F. King, President Jill M. Doherty, Vice-President Pegg~ A. Diekerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631} 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain __ 1~ day of construction ~A constructed //-"~roject cOmplete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen 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 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 1st day of construction ½ constructed v/' Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen 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.: 6467A Date of Receipt of Application: October 2, 2006 Applicant: Albert Safer SCTM#: 98-5-2,3,4 Project Location: 1295 Robinson Lane, Peconic Date of Resolution/Issuance: October 18, 2006 Date of Expiration: October 18, 2008 Reviewed by: Board of Trustees Project Description: To install by hand native plants landward of the concrete bulkhead, to provide a vegetative buffer. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the plan prepared by Creative Environmental Design received on October 2, 2006. Special Conditions: Final inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Board of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 TO: 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: has been and the ( ~ 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 ii 4O FOR ADJ~ ) L( PECONIC 119 !1958 ~UTCHOGUE: LA ' b rtJ Kru Ici ~ ~ ~ . ps ', President James King, Vice-President Artie Foster Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 $outhold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application u,'~/Administrative Permit Amendment/Transfer/Extension ,a~eceived Application: ~l~eceived Fee:$ ~l~ /C~mpleted Application Incomplete SEQRA Classification: Type I Type II Unlisted _~Coordination:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: ,,"~ate of Inspection: ~Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~---"~ublic Hearing He~ ___Resolution: OCT I ,:~.uo NameofApplicant ~1~L .~[)llC"-~./'/~ Address io2 qg- Phone Number:(byl)~ ~ ~. Suffom County Tax Map Number: 1000- .~L~ ifle L~CO~o~ di~t~c~ to cross (If applicable) Address:86~1~0 ~0~dr~ ~--~6 fO ~6kK /~0 GENERAL DATA Land Area (in square feet): I1~,..0:~ -Sq~,.~I24; P~viom use of prope~y: ~ S/~ %~ htended use ofpropeay: Prior permits/approvals for site improvements: ..~ ,Agency ,., . Date ...... No prior permits/approvals for site improvements. Has any permiv'approval ever been revoked or suspended by a governmental agency? /X' No Yes If yes, provide explanation: OBoard of Trustees Applic~on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ~).~ 6~C..~0 ' er c ,n t Area of wetlands on lot: (9 .square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: OM& ~> 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? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Mariner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect, if any, on the wetlay[d$ ant~ tidal w.a_ters of ~e [own~ha_t may result bY reason of such proposed operations (use attachments if appropriate): 617.20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only SEQR PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1. AP,PLICANT/SPONSOR 2. PROJECT ,NAME J Municipality~(~/~lC; T0't~l't ~ ~01~ Coun~ ~t~ 4. PRECISE LOCATION: S~eet Ad'ss and Road Intersections, Prominent landmarks etc -or provide mad 6. DESCRIBE PROJECT BRIEFLY: AMOUNT OF LAND AFFECTED: Initially ~ I acres Ultimately ~ I acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~es [] No If no, describe briefly: WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) []Residential E~] Industrial [~ Commercial r--1Agriculture J--'l Park / Forest / Open Space E~ Other (describe) 10/DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federak State or Local) ~Yes [---] No if yes, list agency name and permit / approval: r'~Yes ~lNo If yes, list agency name and permit / approval: I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor 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 FAF. 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, ['"-]Yes [--~ No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be han~Jwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potanfial for erosion, drainage or flooding problems? Explain hriefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cufiural 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: 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 bdefly: 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-C57 Explain briefly: C7. Other impacts {including chan~e$ in use of egh~r rtuaatit~ 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 ICEAt? fir yes, explain b~iefi~/! E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: [~Yes [~]No PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effecl 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 (t~ magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations con.in 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 determ!~--.t!cn cf slab!tic.nos muct~te~cl i mpcct cf thc prc~-ede~.~c~, c~, th~ ~cv',ronmcnta~ chc~ra ct~r~stJc~ of th~ CEA. Check this box if you have identified one or more pofenlJally 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"i{y~)~ I~ave detarm~n~-d~ b~sed on the information and analysis above and any supporting document~tionl that th~'~opose~ ~cfi~)r WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the masons 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 in Lead Agency Signature of Preparer (If different from responsible officer} Board of Trustees A~p~tion County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPL~ICANT 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 INrTHIS 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 APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES(S), TO ENTER ONTO M-Y PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION Signatu~.~ SWORN TO BEFORE ME THIS_ c~ Board of Trust.es App~ion Ab'r~ORIZATION (where the applicant is not the owner) (print owner of property) (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southo~ees on my behalf. 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the oart of town officers and emnloveas. The numose of this form is to orovide information which can alert the town of nossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, first nar~e, ~iddle initial, unless you are applying~n 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 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 oftbe Town of Southold? "Relationship" includes by blood, marriage, or buginess interes~ "Busines5 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/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 ~hild is (check all that apply): __A) the owner of greater than 5% oftbe shares 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 Signature PrintName day of 200