HomeMy WebLinkAboutTR-6755A
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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, N ew York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 6755A
Date of Receipt of Application: October 22,2007
Applicant: Norman N. Bergen
SCTM#: 70-12-30
Project Location: 1200 Oakwood Drive, Southold
Date of Resolution/Issuance: November 14, 2007
Date of Expiration: November 14, 2009
Reviewed by: Trustee Dave Bergen
Project Description: Trim the phragmites to 12 inches as needed.
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
application prepared by Norman N. Bergen, and received on October 22,2007.
Special Conditions: None.
Inspections: 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.
r~~
James F. King, President
Board of Trustees
JFK:eac
.
.
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
Southold Town Board of Trustees
Field InspectionlWorksession Report
Date/Time: (~{tol 0 ?
Name of Applicant: -N Orm"" r,e., ,'t-^
Name of Agent:
Property Location: SCTM# & Street
--, lJ ~ \ L -],"
Brief Description of proposed action:
h_oo
OolwwJ.
~V() ;,S.svt~^
Cut phl1J.)"",.\0
Type of area to be impacted:
_Saltwater W etland _Freshwater Wetland _Sound Front _Bay Front
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
_Chapt.97 _Chapt. 37 _other
Type of Application: _ Wetland _Coastal Erosion _Amendment VAdministrative
_Emergency
Info needed:
o R; ~,) h.",_d O~};
Modifications:
Conditions:
Present Were: _J.King _J.Doherty _P.Dickerson~. Bergen
Other:
MailedIFaied to:
Date:
Comments of Environmental Technician: Q.0\t- b) h"",) 1 (l,a
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.
~
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Linosio, 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
~ Coastal Erosion Permit Application
~ Wetland Permit Application """"--Administrative Permit
_Amendment/T:JO(~Sion
...::::Jteceived Application: ~I
-.--Received Fee:$ ':S\l.....
-CompletedApp~
~Incomplete
~SEQRA Classification:
Type I_Type II_Unlisted_
~ Coordination:( date sent)
~LWRP Consistency Assessment Form
. CAC Referral Sent:
~ate ofInspection:~
~Receipt ofCAC Report:
~Lead Agency Determination:_
Technical Review:
.p"t;Jic Hearing He~
~Resolution:
Office Use Only
rml r~J? ~ JJ7 [; !. 'I'~I
In\ ",' ........ ,I
U'I' .
U OCT 2 2 2007 ,':'
I ..=J-'
SOilfhoid Town
Board of Trustees
~eRtCeflr
DRltfE., .\ 0 t/TWLl>, NY
Phone Number:~v 7(,J-~1 72-
Suffolk County Tax Map Number: 1000. 7 tJ. '. f'2- - ~o
Property Location: rJer-wf3"EN p, Ne. tf E'c.K. R- p 'j-" N oll,lt-- ~ fr-'i V (~.d
~~ {)IlJ,!lJJtJo'c> 'p/€ -+-- ~Ci~,,q- ~ ~t=k.
(provide LILCO Pol #, distance to cross streets, and location)
Name of ApplicanLNallfhA-N
Address /0.00
AI..
Oft-KuJOOD
AGENT:
(If applicable)
Address:
Phone:
~ Board of Trustees APp~tion
.
GENERAL DATA
Land Area (in square feet):
Area Zoning:
Previous use of property:
,~~~~
I
Intended use of property:
Covenants and Restrictions:
If "Yes", please provide copy.
Yes
/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 ifnecessary): ~tt.- A'~ W ~
:t4 ~r/j;;( </0 l,;z ~AJ~'d 3At/~
~~/~L~'
~ Board of Trustees AP~ation
r
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose oft~e proposed operations: rf4tf t~
~attee ~~ ~ ~,
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
Yes
If yes, how much material will be excavated?
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:
'd;--i~
~
-
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlill1<1sand tidal water~ ()f~e town thatlIla)' res\llt 1JY
'reason of sudiproposed operations (use attachments if appropriate):
.
61
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
..
I PROJECT ID NUMBER
PART 1 . PROJECT INFORMATION
1. APPLICANT I ~,?NSOR
rv;~ If. ~
3.PROJECT LOCATION:
Municipality So Ht<fLj;:>
4. PRECISE LOCATION: Street Addess _ 8fld Road
PINe /V'l:7!-K tZ-#,L IVtJ,<(/7r
County
I~rs~ctions, j'rominent
/?H'T vI enY
landmarks ate - or provide map
~~~
5. IS PROPOSED ACTION: 0 New
D Expansion [j'MOdificaUon I alteration
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT OF LAND AFFECTED:
Initially acres Ultimately acres
8. ~7' PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
L0ves D No If no, describe briefly:
~AT IS PRESENT LAND USE IN VICINITY
l{J Residential D Industrial 0 Commercial
OF PROJECT? (Choose as many as apply.)
DAgriculture D Park I Forest I Open Space
DOlher (describe)
10.. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or Local)
BYes D No If yes, list agency name and permit I approval:
DYes
VALID PERMIT OR APPROVAL?
o If yes, list agency name and permit I approval:
12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
Ges DNa
I CERTIFY THAT THE INFORMA~
I Sponsor Name!Vol(;/)1 /I-,A/ ,
PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
~
Date: lo-~d]
Applicant
Signature
Ifthe action Is a Costal Area, and u are a state agency.
complete the Coastal Assessment Form before proceeding with this assessment
.
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,
PART II. IMPACT ASSESSMENT To be eom leled b Lead A ene
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 0 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.
o Yes 0 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,
rtential for erosion, drainage or flooding problems? Explain briefly: I
C2. rsthetiC' 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:
C4. A community's existing ans or goals as officially adopted, or a change in use or intensity of use 'of land or other natural resources? Explain briefly:
C5. Growth, subsequent develo ent, or related activities likely to be induced by the proposed action? Explain briefly:
C6. Long lenn, short term, cumulative, r other effects not identified in C1~C5? Explain briefly:
\
C7. Other impacts (including changes in use f either quantity or ty e of energy? Explain briefly:
D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL
ENVIRONMENTAL AREA CEA? If es, ex lain bri
o Yes ONO
E. IS THERE, OR IS THERE L1KEL V TO BE, CONTROVERSY ELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain:
o Yes ONO
PART III. DETERMINATION OF SIGNIFICANCE (To be complete by Agency)
INSTRUCTIONS: For each adverse effect identified above, deler ine whether it is substantial, large, important or otherwise significant. Each
effect should be assessed in connection with its (a) setting (i.e. ur n or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e)
geographic scope; and (f) magnitude. If necessary, add attachme s or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been i ntifted and adequately addressed. If question d of part ii was checked
~'eg, tt:le determinati9R 9fEiQnitic3nG8-fR\;l5~evaluate-the ~teAtiaHmf*i ~.getjeA GA tRe CFIv iroflffiultal characteristiC3< of the CCA.
Check this box if you have identified one or more potentially large or signifi nt adverse impacts which MAY occur. Then proceed direcUy to the FUL
EAF and/or prepare a positive declaration.
Check'tfUsubox if Yl)'uhave-delermmecf;based-on-iheln-formation and analy 'sabove and' any supporting- documentatlon,- tha-ithe-proposediictlo-
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
Pnnt 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
~)t. ~~/ ~~ BEINGDULYSWORN
DEPOSES AND IRMS THA HE/SHE IS APPLICANT FOR THE ABOVE
DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE
TRUE TO THE BEST OF HISIHER 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.
~Si~~
SWORN TO BEFORE ME THIS OlJ~ DAY OF (') 0/ <
2007
,~
~'0 rn. ~AfJ,t
olary Pubhc
N M. STANDISH
NotI,y Ie, Stare of New 'lbrk
. ISTlil641lO8
"-_ Qual in SuffllIk CounlY II
_llIlllon resApri/9.20_
.
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APPLlCANT/AGENTIREPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of Southold.s Code of Ethics orohibits conflicts ofinterest on the Dart of town officers and emo]ovees. The Durnase of
this form is to orovide information which can alert the town of nos sible conflicts of interest and allow it to take whatever action is
necessarY to avoid same. .
YOUR NAME: ~1ltJ11}-,/ If. C-3~d
(Last name, first name. -I1liddte initial. unless yo'u 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, parent, or child) have a relationship with any officer or 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.
YES
NO
...-/'
If you answered "YES", complete the balance ofthis form and date and sign where indicated.
Name of person employed by the Town of Southold
Title or position ofthat 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 applic~nt
(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
2002
t W- C3-~
Form TS I
APPROVED BY
BOARD OF TRUSTEES
TOWN OF SOUTHOlD
DATE . //j/V/tJ 7
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