HomeMy WebLinkAboutTR-6591E
.
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Ghosio, Jr.
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
EMERGENCY WETLANDS PERMIT
Permit No.: 6591E
Date of Receipt of Application: April 30, 2007
Applicant: Joan S. York
SCTM#: 123-5-29
Project Location: 4025 Camp Mineola Rd., Mattituck
Date of Resolutionflssuance: May 3, 2007
Date of Expiration: NfA
Reviewed by: Board of Trustees
Project Description: A temporary repair of the existing bulkhead using plywood
and place approx. 10 cy. of clean fill in the southwest corner of the bulkhead.
Findings: The project meets all the requirements for issuance of an Emergency
Wetlands Permit as determined by the Board of Trustees. The issuance of the
Emergency Wetlands Permit allows for the operations as indicated on the
application received on April 30, 2007.
Special Conditions: A full Wetland Permit must be obtained in order to conduct
any further activity on the bulkhead.
This is not a determination from any other agency.
{la~ o:?'!?-'
)J;-~es F. King, p:lt
Board of Trustees
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Southhold Town
Boaul of Trustees
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Gnosio, Jr.
Town Hall
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
(p~ I f.
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Applicatioy ~
_Wetland Permit Application ~ Administrative Permit C::/1neI'3ene.v
~ Amendment'Trans erlE tension /
eceived Application: '-/ 30 07
Received Fee:$ 50
...0ompleted Application~
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted~
_Coordination:(date sent)
_LWRP Consistency Assessment Form
_ CAC Referral Sent:
_Date of Inspection:
_Receipt ofCAC Report:
_Lead Agency Determination:_
Technical Review:
./Public Hearing HeldJl ~ 5JJlO)
Resolution:
fB)IeCIt8W!C~
/Ill APR 3 0 2007 IW
Southhold Ton
Board 01 Trustees
Name of Applicant _~\tM S. Y OX \<---.
AddressL-<6\l-Y ~0~ W(b~\UW ~. ~:
f\.J .....Lon" 11\" ~. ,~~_.._-~
t1'(\V--\..ilL.JV'1 VLL. PhoneNumbe0(0)S - ~[9 -it:;:- "'..= :
Suffolk County Tax Map Number: 1000 - 41~ <ts ~'1 l"L.?::.. -S - 2."'-4
Property LocationY02.~c.~p \\I\We..0ICL '2.-<1, \\A.f~ \l\-uJe.., n ''f-
LlLCO tf~ tdwM-u ~b2~ \-~<=r4~ (1)\t.()\\\lM.e~ ~
(provide LILCO Pole #, distance to cross streets, and location)
AiF IT:_ ~e5~ro~nk
(If applicable)
Address: ~ O. DOX d<;.;2..
f!1otJJ.-, tude- / IV Y / (9:) ;2
Phone: ;;2915- 0 liS-
~\y
~rd of Trustees APPlicatiJlt
GENERAL DATA
Area Zoning:
Land Area (in square feet): II I Z. :; ()
V-6(+ '
Vt/S(~~ciQ
V~\ J~\cL.Q
Previous use of property:
Intended use of property:
Covenants and Restrictions: Yes ~ No
If "Yes", please provide copy.
Prior permits/approvals for site improvements:
Agency
Date
lLA). , 9---"
,\~rior permits/approvals for site improvements.
Has any permit/approval ever been revoked or susp~ by a govermnental agency?
No Yes
--
If yes, provide explanation:
Project Description (use attachments ifnecessary):
~~-
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ef 'o~ ~~~~
Of(
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Vt'lJ.J +~ u S601tt ~f CJ" 'rJ..t't #-
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4Irrd of Trustees APPlicati~
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose ofthe proposed operations:
}AJU o-<fleA Lr.. rlLO ~O I ~ ~ \0
Area ofwetIands on lot:
~ f\ I 9-----" square feet
-
~/o
Percent coverage of lot:
Closest distance between nearest existing structure and upland
r-
edge of wetlands: l..- ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: "2- S-- feet
Does the project involve excavation or tilling?
No
Yes
If yes, how much material will be excavated? 0 cubic yards
How much material will be filled? .~ cubic yards
Depth of which material will be removed or deposited:~ feet
Proposed slope throughout the area of operations: \ e V:Z-\
Manner in which material will be removed or deposited:1x~b L.J\--c-
Statement of the effect, if any, on the wetl~ds an~tidfl!waters !lftl1e towntha!Il!<lJ' ~e_s~ltlJ),
-reason of such proposed operations (use attachments if appropriate):
\u~1 ~
.
PROJECT 10 NUMBER
,-
617.20
APPENDIX C
STATE ENVIRONMENTAL QUALITY REVIEW
SHORT ENVIRONMENTAL ASSESSMENT FORM
for UNLISTED ACTIONS Qnly
(To be completed by Applicant or Project Sponsor)
.
SEQR
PART 1 - PROJECT INFORMATION
2. PROJECT NAME
Municipality
County
s
4. PRECISE lOCATION: Street Addess and Road Intersections. Prominent landmarks
02:{ ucl I~- _ \l'1~
5. IS PROPOSED
6. DESCRIBE PROJECT BRIEFLY:
-~-{~~~
)~(
~ b~ecvL
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
c:r;;s 0 No If no, describe briefly:
~T IS PRESENT LAND USE IN VICINITY
L:J Residential D Industrial D Commercial
OF PROJECT? (Choose as many as apply.)
DAgricUllUre D Park I Forest I Open Space
DOther (describe)
10.. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING,
AGENCY (Federal, State or Local)
~ DNa ~list agency n.~d permit I pproval:
\.-L ~
NOW OR ULTIMA TEL Y FROM ANY OTHER GOVERNMENTAL
rr:-DOES
DYes
s
r
'oGC-
AI'lTASPEC OrTRE ACTION HAVE 1\ f'fTL Y VALID PERMTT OR APPROVAL?
~ If yes, list agency name and permit I approval:
12. AS A ~':!.1T OF
[Jy es l:::fNo
I CERTIFY
PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
THAT
PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant J Spo
Signature
Date"
-60 -0
If the action is a ostal Area, and you are a state agency,
omplete the Coastal Assessment Form before proceeding with this assessment
.
.
PARTII. IMPACT ASSESSMENT (To be completed bv lead Agency)
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.
DYes DNo
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 DNo
C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be han~written, 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 .. -,.~ .. _. .- ~~-~ ._~_....- ... 'I
C2. Aesthetic. agricultural, archaeological, historic, or other nalural or cultural resources; or community or neighborhood character? Explain briefly:
I ... -.... j
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
I ....- -..- .. _..,,- .. _M. O'. . ... j
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 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 Cl-CS? Explain briefly:
I J
C7. rrimpaG'S (includ,ngchanges inuse of either quantity or type of energy? Explain briefly:
l
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 D No I
E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? II yes explain: I
DYes DNo I
PART 111- 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.Gete~mjnatiM.(Jf.sigRifiGaRGeffiust-evaluate--the-f30tential-imf*)et-ef-the.preJ3es-e€l--aetieA'on-the-eflVironmentalchar-acteristics-ot-the-eEA.
Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL
EAF andlor prepare a positive declaration.
. ched<ThTs"box ifyou"have-deliirmlnecf,- base;fon-fhe iiiformation and analysis 'above and- any supporting- docUmentation, th',lt'the -proposed a-Ctlo-
WILL NOT result in any significant adverse environmental impacts AND provide. on attachments as necessary, the reasons supporting thi
determination.
Name of Lead Agency
Dale
Print or Type Name of ResponSible Officer 10 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
g.
L
BEING DUL Y SWORN
DEPOSES AND AFFIRMS T AT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF IllSIHER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTHIN TIllS 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 TIllS
APPLICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIRAGENT(S) OR
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONJUNCTION WITH REVIEW OF TIllS APPLICATION.
L
SWORN TO BEFORE ME THIS
J()
DAY OF f../u./
,20 G' 7'
~ ~k<;-
Notary Public
PATRICIA fllCHERT .'
NotIry 1'IIbIlC:. StilIIl'oI NeW lllrt
, "',"NO. 3D-177..'JI54
au.If!ed.itl~I~~
CoIllflll$f1Dll flIph~ ~
;.....
e'ard of Trustees.. APPlica.
AUTHORIZATION
(where the applicant is not
I,~Av\ ~.~ol(l
(print owner f property)
~
the owner)
residing
at2.'lsl~ -I) <;.0Y~\-ov.) Sf-
(mailing address)
A y\ L..,c ~nA . \J:; . L- L-l-O(..
~AV\Le~ ~\-~lbt1v\L
(Con+ro..c.fc,,--) .;2'18'-011 f)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
c.
~
8
.
<.
APPLICANT/AGENTIREPRESENTATlVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart o[to",o officers and emo)ovees. The Duroose of
this form is to orovide information which can alert the town ofoossible conflicts of interest and allow it to take whatever action is
necessary to avoid same. '
YOUR NAME:
:Joa.i"\ 'Iork
(Last name, first name, .I11iddle initial. up-less you are applying in the name of
someone else or other entity, such as a company. lfse, 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 f'Mer8&lO,( V
Coastal Erosion {
Mooring
Planning
Do you personally (or through your corupany, spouse, sibling, parent, Of child) have a relationship with any officer or employee
of the Town o:fSouth~ld? "Relationship" includes by blood, tT\arriage, or bus'iness iweresl <<Business interesf~ 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% o~ares.
YES NO ~
If you answered "YES", complete the balance ofthis fonn 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 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, pare~t, o'r child is (check alt"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 own<?f 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 t -is ~ day 0 '
Signature
Print Name
200 -.J
Form TS 1