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Home My WebLink AboutTR-6731A . . 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 Permit No.: 6731A Date of Receipt of Application: October 2, 2007 Applicant: John Keitt SCTM#: 81-1-19 Project Location: 280 Basin Rd., Southold Date of Resolution/Issuance: October 3, 2007 Date of Expiration: October 3, 2009 Reviewed by: Board of Trustees Project Description: To install (1) 1200 gallon septic tank no closer than 75' from the bulkhead and (1) 8'X12' leaching pool no closer than 100' from the bulkhead and abandon and fill two existing block pools. 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 revised survey, received on October 5, 2007, by Coastline Cesspool & Drain Service. Conditions: None 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. Ja~g~fi Board of Trustees '---- I- .-L 11 L _"~"",, EI_<-_ ~~'"- N-...... ,-- .. - ..,-....'''.-..-- --...- ..,,"~ ...".,'" 1000 ~'''''''''''''''''''~_TtD ~' '.-~"'-'.',7.u~';;!;.~". "'>oJ""",,"'"''''''':'-I''' ............" ,.. """".cao;r ., . . CJ uou PROI'ERTY ilIAP ", ~--~---------------~ ;';";'<;;,~-----.~, ~..,,",,~ ~-- if/ ...~1 /' II SOUTHOLD 'I F,[),28 ~;'. ,~ '" '" ,~ " ". '" ,:t,,,,, ".1 ,~ (<II;' I " ,...... , "'''0' lO.' ", lO.t " @ ... y '."'<' $ 'U ~.' ." !, 1 1 . to.'"'' ",' >." '" , 1 ,,! '1 ", .., g . . . 2.",,, . l' I 'I', :1 , -+- @ _......,'~-.,-. .....-..".--.-- .....--.....-"',-- .""""","""""'"'''''' (I';'_T...:.-"'""",,""'''' """,.""",_1>>"',_"" .owr....roo"""'"..."'''. ...._,,,,"""""",,'. (i) COLtHY OF SlJ"FOLK @ Rea Property Tox$ervlceAgency ~tyc...I...1lNrtItoIl,NlllSil1 " """'."Ol, .. . .. - ....,,, co... "_'~', ", ......."., ... ,,-_ .", 'OLeo."", """'''''' """"----,------,,... .00 r.. " _~,_ ;: " ::.::===== __~""t..,.._ NCTH _of 5DUTflOlO 121l . _.oO ".,......-I2.1A-" 12.1'"'' _... ....'" 1000 . . . I"" SECTION NO 081 Pl<<lPERTYY/lP ~.,"" t,r.>: ~--"""; AS'O[JTHOIJD (TOWN HARBOR) r-, , , 'S 83.52'45" [ .:000 '.CU:H~ ~ Southold Town ICH W....TER MAAI< Board of Trust APPARENT H . . . k:-~ ~UlK~ ~- . , i ~ i , j + I I sf ",j , I aI " -, f~:,: ''I : ",., ._~ ttllc, ~ c, ',.-.:.,.- :'<~f~ A.,.,. ," ~{'...~- WOOD BULKHEAD ;, ~I ---..A....__ .... ""'IT 22,~ 16.S' '. .. 13.1' 22.,' 22.0' " .. MY - fIIOOf' OVER_ SlArr STOOP e APPROVED BY GOARD OF TRUSTEES TOWN OF SOUTHOLD ' I ....';;; /0/ ~ 67 _~_ r-- iF. ~ ___ L.... .. E-. Cl '-'l '" ~ SLATE ALl( '. ~g, z ~I , BA ~ ~ ~ ~ ~ ~ G OCT - 5 2007 ~ WOOD BUU(H(AD \\'O()o BULKHEAD 16.7' . . '-000 fiE ''''~~ ~.c/.6v , &v ~I l i" '6.04' ~ -- o j I . 1~,~~ " I ~ I C\l "' '-' --: ! ~ . ~ c 'Cl ' ~ ., ..., g x7cX P i" I ' ~ 1-(~M~ '~il r Q, &>c,,'3 ~,r : .' '. Ou"!J""" il ~ .-; I, I' ;/.: / /II . . " . .. J O"';ifH~ " ~l N Ol N Ol ~ ~ o N It) ~ . ..,. o . f James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob 13nosio, Jr.. BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD . Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 _Coastal Erosion Permit Application Welland Permit Application L Administrative Permit Amendment/Transfer/Extension /!'teceived Application: 10 !ill 01 ,LReceived Fee:$ ~ ~ ~mpleted Application /()/.}.!m. _Incomplete _ SEQRA Classification: Type I_Type II_Unlisted_ _ Coordination:( date sent) _LWRP Consistency Assessment Form _ CAC Referral Sent: . ~e of Inspection: /0 (bl _Receipt ofCAC Report: _Lead Agency Determination:_ Technical Review: --.I.J'llblicHearingHeld: 10(0/0') Resolution: Office Use Only /0/;;./(;,7 sD (?ol ((0.# ~[E ~ _ ~J_~~\i~ liUr- .\\! E :. OCT- 2 leDl : i.' -~~~ SOlltllOld Town RO.3rrl of Tru.c~rp,:; Name of Applicant 3d:1f\ ~y-\-\- Address 3btJ Fo <:.,-\- 8 -r-~ 'n s-t f\p~. ~E. \ o(),).&. \::)o,...)\'\Oi'\< "-JL~ PhoneNumber:~~ >--I,So.-qlq~ Suffolk County Tax Map Number: 1000 - '0 \ - Cl \ \ q Property Location: \?x,S'\l) ~ (provide LILCO Pole #, distance to cross streets, and AGENT: e.cn<<;\\;'(\.R 0,<\.?1'\ C\ Oen',t) ~ex\.i, ~ (If applicable) Address: 4~~ h'\\rlccr ln~ 0.d\1:::tx.W, \.)\j \\q~'::J Phone: S\lo-gO:.~-\~:'\<:1- lA...)\ \ \ ~Board of Trustees APPlicJllbn GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Yes X No , 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: Project Description (use attachments if necessary): I",x\n\\ (,\ \l..--r--. ~\\CY\ ~~'c ~.("\\.... - (\\ ~X \~ \~ocn\l\~ p--n\. t\'cY:lrrl.Dl\" ~\ \ \ ~ nO 9)"('\S;-\\(,,\~ 'o\c::U::... ~\::'::,. . PROJECT ID NUMBER 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 SEQR PART 1 - PROJECT INFORMATION 1. APPLICANT I SPONSOR ~ Co ---:si \<\ 3.PROJECT LOCATION: Municipality County 4, PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks ete - or orovide map d.?Ja bos\'{) fl.a, So0\-no\d SC:"\{'('I % 1000- '6 \- \ -\<=i 5. IS PROPOSED ACTION: D New D Expansion ~ Modification I alteration 6. DESCRIBE PROJECT BRIEFLY: :::L><>~.>a \ \ C I) \ oc:o ~C\ \\0<1, 5<_~'\C- ~,,"" ,,(\ ') .g!( \ d.. \~O.C.X\ ~ ~ ;\~ ' \=\''00.:<\0.01).... 5;-, \ \ Q. '/. \ <0,+1 ()-3 Ie\<::><:.\<- ~\:s.. 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? L3l Yes D No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY ~ Residential D Industrial D Commercial OF PROJECT? (Choose as many as apply.) DAgriCUJlUre D Park I Forest I Open Space D Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) DYes ~ No If yes, list agency name and permit I approval: 11. uut:.::i DYes ANY A::iPEC t Ur I HI::. AC IIUN HAV!: A CURRENTLY VAOb PERMIT OR - APPROVAL? ~ No If yes, list agency name and permit I approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION? Oves DNo I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicanl I Sponsor Name v-,:" \\ ,0-,..-., \.)..J. \t:k"", Coa~\'~ C~F \ "D<<>';iJ1lt~<., \D\<"'\DI 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 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 617.67 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, 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 natural or cultural resources; or community or neighborhood character? Explain briefly: I 1 C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: I - l 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 C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: I C6. Long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly. I I C7. Other impacts (including changes in use of either quantity or tyoe of energy? Explain briefly: 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: I DYes D No I E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain. DYes DNO 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,too4eter-minatioR ofsigAHiGaflGe mllst eYaluat~teRtiaHm~-e~-a€lielloll"theenvifenmental-eftaraderisttesofU,e CCA. Check this box iryou have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FUL EAF and/or prepare a positive declaration. Chec::kThlsbox.W You have deIermTnea', "based"on "ftie Information and analysis 'above and' any supporting documentation, thaI the "proposed' ac"tiC;' WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting lhi determination. Name of Lead Agency Date Pnnl 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 v0cuIV'PK A). ~~!::.. BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEI'vlENTS 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 REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. #~~ Signature SWORN TO BEFORE ME THIS d. DAY OF (}(1715B&e ,2007 ELIZABETH A STATHIS NOTARY PUBLIC, State of NewYorlc No.01ST6008173.SuffrnkCo~ TermExpiresJune8.~ t-...... : CIR;TLlNE CE'SSPiXl. .........,. . F~ He. ;631-7~4-B2~1 .. 02 <3!107 02;0SF'M 1"1 aoard of TruSt... APplicAtion J.~IIJ\TIOIr (whe~. the .ppl1ca~t ia not the own.~) J I, ~>('/(/ /r;;t'~( - (prInt own~r of property) r881<1109 .It 320 I'" ;j;77"{ (maHing .t~..) ~I' .l(:t?r/~d:'...E:.~i/ /~Cndo hereby 4uthorbe ' ? I' ( -'gellt: ) c:....,} ?Z'-"/t' 6~?.do";;~,,,,,,.::'to .lpplV for .pomit(sl frClll the Soutno14 Board of Town Trasteea o~ my bahAlf. ~ pA- 7ner'. . ~~ ~ .-?'; g ~n. ure} 8 ~d of Trustees APPlicati~ Purpose ofthe proposed operations: WETLANDITRUSTEE LANDS APPLICATION DATA R,,~'o(€ ~; \<:...\-;nCj ~.e0\'- s'5'~ <<"I Area of wetlands on lot: o square feet Percent coverage of lot: o % Closest distance between nearest existing structure and upland edge of wetlands: ... / - '6 feet Closest distance between nearest proposed structure and upland edge of wetlands: + /_ \LD feet Does the project involve excavation or filling? No 1< Yes If yes, how much material will be excavated? .50 cubic yards How much material will be filled? )5 cubic yards Depth of which material will be removed or deposited: n feet Proposed slope throughout the area of operations: nD cY\o.(\qe- Manner in which material will be removed or deposited: \::::X::~C>OI6e- Statement ofthe effect, if any, on the wetlands and tidalwaters of the town that may resllit by ...- ---.-.. ....... -.-. -- ---..- reason of such proposed operations (use attachments if appropriate): . . APPLICANT/AGENT/REPRESENTATlVE TRANSACTIONAL DISCLOSURE FORM The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emolovees. The Durnose of this fonn 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: PO"", \1..1', \\\Qm \. a , C' no<i;\-\\ ~ rps.~\ ,,'\::)ro;() s,u<-, (Last name, first name, .r,niddle initial. unless you are applying i 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 pial Exemption from plat Of official map Other (If''Other"', name the activity,) Building Trustee Coastal Erosion Mooring Planning """" Do you personally (or through your company. spouse, sibling, parent, Of child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or bus'iness interest. "Business interest" means a business, including a partnership, in which the town officer or employee has even a partial ownership of Cor employment by) a corporation in which the town officer or employee owns more than 5% of the shares. YES NO v ffyou answered "YES", complete the balance of this form aod 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 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 2"^ day of O::..-\o'oec- 200 '::1 Signature w\.oo \1") '<<'-\k.'),~<ty Print Name u.:l\ \\'0 "" ~, 0..-'1<.. Form TS I