HomeMy WebLinkAboutTR-6756A
.
.
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
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
1 st day of construction
Yo constructed
/" Project complete, compliance inspection.
.
.
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.: 6756A
Date of Receipt of Application: October 15, 2007
Applicant: Warren Jackson
SCTM#: 115-12-4
Project Location: 300 Deep Hole Drive, Mattituck
Date of Resolution/Issuance: November 14, 2007
Date of Expiration: November 14, 2009
Reviewed by: Board of Trustees
Project Description: Cut the phragmites to 12" 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
site plan prepared by Warren Jackson, received on October 15, 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.
.~o<~
James F. King, President
Board of Trustees
JFK:eac
.
.
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
TO: ~((("f) :JQcl"'Sdf'\
Please be advised that your application dated CJc..-tolDer 1::)/ OlCXJ7 has
been reviewed by this Board at the regular meeting of A)olfeMbel /'1" ~?
and your application has been approved pending the completion of the
following items checked off below.
Revised Plans for proposed project
Pre-Construction Hay Bale Line Inspection Fee ($50.00)
1st Day of Construction ($50.00)
y, Constructed ($50.00)
~inallnspection Fee ($50.00)
Dock Fees ($3.00 per sq. ft.)
Permit fees are now due. Please make check or money order payable to Town
of Southold. The fee is computed below according to the schedule of rates as
set forth in Chapter 275 of the Southold Town Code.
The following fee must be paid within 90 days or re-application fees will be
necessary. You will receive your permit upon completion ofthe above.
COMPUTATION OF PERMIT FEES:
c/ 00
TOTAL FEES DUE: $ :J 0 .-
BY: James F. King, President
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
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Southold Town Board of Trustees
Field InspectionlW orksession Report
Date/Time:
Name of Applicant:
Wo.n"'e"
J o LborJ
Name of Agent:
Property Location: SCTM# & Street
\ \ '> - It. -'-I
'3 00 \2ur I-f.,~ On J /'AA{l..W
Brief Description of proposed action:
G..-.+ ~~0.J"'\k"
Type of area to be impacted:
Saltwater Wetland Freshwater Wetland _Sound Front _Bay Front
,
Distance of proposed work to edge of above:
Part of Town Code proposed work falls under:
_Chap!.97 _Chap!. 37 _oilier
Type of Application: _ Wetland _Coastal Erosion _Amendment _Administrative
_Emergency
Info needed:
Modifications:
Conditions:
Present Were: _J.King _J.Doherty _P.Dickerson _D. Bergen
Oilier:
Mailed/Faxed to:
Date:
Comments of Environmental Technician:
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300 Deep Hole Dr
Warren W. Jackson
Private recreational
MeBn Low Water
72 31'/ 40 59'
Applicant:
Purpose:
Datum:
Locus:
docking
f5) ~ (C ~ ~ \'U ~fn1
lnl OCT 1 5 2007 I.W
Warren W. Jackson
Prepared by;
page lof2
Southhold Town
Board of Trustees
.
..
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
Office Use Only ~~~!:nHW
_Coastal Erosion Permit Application
_Wetland Permit Application X Administrative Permit OCT 1 5 2007
~ Amendment/Transfer/Extension
~eceived Application: /0/' :;-/07
Received Fee:$ "'iZ)<::9- Soutllhold Town
......-completed Application I '0/ n(OJ Boanl of Trustees
Incom lete
P
_SEQRA Classification:
Type I_Type II_Unlisted_
_ Coordmation:( date sent)
_ L WRP Consistency Assessment Form
CAC Referral Sent:
...,.d)ate ofInspection: J J J ft; { Cf}
_Receipt ofCAC Report!
_Lead Agency Determination:_
Technical Review:
---.Yublic Hearing Held: I (( / If f ~ J
_Resolution:
Name of Applicant /.AlA R 2J!.,J tJ 71C kS()'/
Address .10D {)E/~ HaLL; LJ/2 /JJ,4 T7I7C/tk
I
/"v': '1- Phone NumberiJt1 :J... '1 ~ - ,1 2. Z-O
Suffolk County Tax Map Number: 1000. lj 7 j %81 / If: ~ I~ - 'I
Property Location: .]()O ~/-~e-p Hd, /lor /J7477'/7v'CL-, II..( J/fJl
300 f{- .'/1..J.f. Q~ N..it./ )~no/J: IRI/(, iJt5/ 5"icle
(provide LILCO Pole #, distance to cross streets, and location) JtS I
AGENT:
(If applicable)
Address:
Phone:
~rd of Trustees APPlicat~
GENERAL DATA
Land Area (in square feet): .) S- Jll1!. I;'
..]&!Oco S~ ~
, (
Area Zoning: f2 -/ 0
Previous use of property: rZt 5 lei l' -" -hXJ {
Intended use of property: (/af/dp.......full
Covenants and Restrictions: Yes
If "Yes", please provide copy.
~o
Prior permits/approvals for site improvements:
Agency
I!l2IIJ nr- ',..vslus -mu.. of <;u..JiJ.{
Date
- Ot?d:. flIlttf,l7r;lJ~
S' /n-ln -
l
~/.J19 }
)'1~/9? ~ r7.Jr
~ If) 61'- C; } - Ol3J 0
tt- 1-'I7.3f' _dIIFl!O(bOL
nil" "-lIr... 7 (iI,rrJ .~I/...f,..tel }
/I~'1-I 08 (
_ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency?
~o_ Yes
If yes, provide explanation:
Project Description (use attachments if necessary):
----12e1 {/15..f Fe t/J1/r
uJ /COl.l..j.,AL 16115/(
S,(J/Yf/l
Yo
tv! f/Y f71JC-1J11 'T/ I~ ('
-
ro"'/'O L t'J-tOiV711/ o~
7?5
4111rrd of Trustees APPlica~
WETLANDITRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: -rf1 l""'~ rJ."'AjI'H"/z't. f
n..A rYlJ4I"-?h,,..; IJ. f J'L" /IQL L /1..1 10 fk"'1'f
-fa slow WHj..n '1-'0,./ XI^,,~ J(} lid V /V1t.f;vt- 9 rASS"J 10 'j'~/A/
square feet
Area of wetlands on lot:
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?
v"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:
Manner in which material will be removed or deposited:
uStatement oftl1e effect, if any, on the wet1<l1lds and tidalwaters of the town thatlIlal'res~ltQY
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
(To be compleled by Applicant or Project Sponsor)
2. PROJECT NAME
..
PROJECT ID NUMBER
SEQR
PART 1. PROJECT INFORMATION
1. APPLICANT I SPONSOR
(l,. tV.
3.PROJECT LOCATION: .3 4?
Municipality m,(/ T71:1l County S V~ l L~
4. PRECISE LOCATION: Street Ad ess and Road Intersection, Prominent landmarks ete - or provide map
.JOO 4etp 4O~.I//
IY74+-hh.;v!, 119 rL
5. IS PROPOSED ACTION:
New
D Expansion
Modification / alteration
6. DESCRIBE PROJECT BRIEFLY: " n L ..oK,t- ""r. . .I.. - L - 'L I. f
---., ""... pt-r- ~ . /11,-' 1'V TV I.,.... f t-R f Iyf I' rU! /1'0/'
M/J'-vIrJ,./ 11 I- /'t II 741/ i,v 13 ~ltfl W .f'/,;V /YhfrtJ -h,4-' 11'4/
1J1/64/ 1'-14,J,u 'j'dlff'd 'h 'JWt./
7. AMOUNT OF LAND AFFECTED:
Initially acres
8. WILL PROPOSED ACTION COMPLY
~ DNa
Ultimately acres
WITH EXISTING ZONING OR OTHER RESTRICTIONS?
If no, describe briefly:
;:!'!HY IS PRESENT LAND USE IN VICINITY
~esjdenlial Dlndustrial DCommercial
OF PROJECT? (Choose as many as apply.)
DAgriCUItUre D Park I Forest I Open Space
OOther (describe)
10.' DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AGENCY (Federal, State or local)
DYes D No If yes, list agency name and permit I approval:
DYes
I HI::. ACIION HAVE; A CURRENTLY VALID PERMIT OR APPROVAL?
If yes, list agency name and permit I approval:
12. AS A ~UJ..T OF
es l=:::tfjo
I CERTIFY
PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
Applicant
THAT
ATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Date:
Signature
If the act n Is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
.
..
PART II. IMPACT ASSESSMENT ITa be cornoleted by Lead Agency)
A. DOES ACTION EXCEED ANV TYPE I THRESHOLD IN 6 NVCRR, PART 617.4? If yes, coordinate the review process and use the FULL EAF.
Dves DNa
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NVCRR, PART 617.6? If No, a negative
declaration may be superseded by another involved agency.
Dves DNa
c. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwritten, if legible)
C1. Existing air quality, sulface 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 I
C3. Vegetation or fauna. fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
I 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 brieny:
I I
C5. Growth, subsequent development, or related activities likely 10 be induced by the proposed action? Explain briefly:
I "".,,^.,,-- I
C6. Long term, short term, cumulative, or other effects not identified in C1wC5? Explain briefly:
I I
C7. Otherim aels including chanQes in use of either Quantity or type 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
DVes DNa I
E. IS THERE, OR IS THERE L1KEL V TO BE. CONTROVERSV RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
Dves DNa I 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 deter.mh:.'Jati9A sf signiflGaflGefFlu5:t evaluate--llle-peteA-tial impact of th8f>>'6~etieA~e;F1 v ir6F1mefltBI Gharacteri3tic.s of the CCA.
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 and/or prepare a positive declaration.
CheckThTs"boilfyouhavEi"detemiTneif,based-on-ftie -information and analysis above and- any supporting- documentatlon,-th'aftheproposed acUo'
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
Print 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)
..
.
..
APPLICANT/AGENTnREPRESENTATIVE
TRANSACTIONAL DISCLOSURE. FORM
The Town of South old's Code of Ethics nrohibits conflicts of interest on the Dart of town officers and emolovees. The Durnase 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. '
~
... ) A t.- r..s 6"-" W,q !<Al-/J,J
(Last name, first nanie, J)1iddle 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,)'
YOUR NAME:
tAl.
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
v-
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 bus'iness 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 I~
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 orthat 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 ownl?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
Form TS 1
J~ day of
~oard of
..
Trustees Application
County of Suffolk
State of New York
fA) A1Ule ,J tJ - Jlk-K s () tJ 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 illS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK
WILL BE DONE IN THE MANNER SET FORTH IN 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 ARlSING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING TillS
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 TillS APPLICATION.
SWORN TO BEFORE ME THIS
/-11
~ DAY OF
()ct;;L ,20~ 7
~ :1
./
Notary Public
GAIL L. ASSETTO
Notary Public, Stale of New York
No. 01 t's50225-A3
QU!~::~td in Suifolk County 10
CCr.nmission ExplftS Jun 16, ~O_