HomeMy WebLinkAboutTR-6856A
.
.
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
15t day of construction
% constructed
V 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.: 6856A
Date of Receipt of Application: April 7, 2008
Applicant: Steve Wick
SCTM#: 103-1-19.7
Project Location: 1541 Stillwater Avenue (Vineyard View Drive), Cutchogue
Date of Resolution/Issuance: April 16, 2008
Date of Expiration: April 16, 2010
Reviewed by: Board of Trustees
Project Description: Trim phragmites to 12" in height; replant along the easterly
property line with native shrubs and trees in the area of the mosquito ditch.
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
survey prepared by Roderick Van Tuyl, P.C., last dated February 6, 1986, and
received on April 7, 2008.
Special Conditions: A 50' Non-Disturbance Buffer is established in the southern
most corner of the property.
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 South old Town Code, a
Wetland Permit will be required.
This is not a determination from any other agency.
r&<1!
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:
SIeve- (,Jtck
Please be advised that your application dated A-r-.'I 7 ~oo8' has
been reviewed by this Board at the regular meetin of tr:/ /~ ~
and your application has been approved pending the co pretion 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)
% Constructed ($50.00)
V Final Inspection 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 of the above.
COMPUTATION OF PERMIT FEES:
c6?-
TOTAL FEES DUE: $.50
BY: James F. King, President
Board of Trustees
.,
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
Southold Town Board of Trustees
FIeld InspectlOn/W orksession Report L<.J
D"wr~e 7/11/01 t/~/D'7fh~~'
N="fAPPh'~'~ !Ank: k<k # %'Vi-'1/73
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Name of Agent:
Property Location: SCTM# & Street
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roposed action:
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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:
- Chapt'1f'7 _ Chapt ~ _other
.:nS )] )
Type of Application: Wetland Coastal Erosion Amendment Administrative
Emergency - _
Info needed:
~I ~J< ~ ~JL 16CA"k
IS' ~ I .-- A"'d<... .+ ~"'..... 'i.... ,~
Modifications:
Conditions:
Present Were: t.--("King L.-J.'Doherty ~ickerson 5 Bergen
Other:
~ob Ghosio, Jr.
MailedlFaxed to:
Date:
Comments of Environmental Technician:
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SUFFOLK CO. TAX MAP DESIGNATION:
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1. Any further subdivision of the property , ,
QYned by Blum and Littell. that this pro-
posed*subdivision is part of, shall be
treated as a major subdivision with the map
being filed in the office of the County Clerk.
2. No lot shall be changed in ~' manner
unless authorized by the Suffolk County
Planning Board.
3. Approval of this subdivision shall be
lIlB.de subject to the meeting of the require-
ments and standards of the SUffolk County
Department of Health Serv1.cea.
4. No sanitary disposal facility shall be
located within 100 feet of the drainage ditch
emptying intq Eugene's Creek and the edge of
any tidal meadow bordering on the creek.
5. All residential structures shall be
located at least 100 feet back from the edge
of the tidal meadow bordering Eugene's Creek.
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I 6. There shall not be any discharge of storm-
I vater runoff resulting from the development
I and improvement of the Iota directly into
I the drainage ditch emptying into Eugene's
Creek or into any tidal wetland bordering
the creek.
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7. A conservation easement having a depth
of 50 feet shall be established along the
tidal wetlands.
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SOUTHOLD
SECTION NO
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103
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James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob linusio; 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
~ Coastal Erosion Permit Applicatiory--
~ Welland Permit Application ~ Administrative Permit
/ Amendment/Tra er/ tension
Deceived Application: '1:!f
KReceived Fee:$ ")?)c8
~ Completed Application
~Incomplete
~SEQRA Classification:
Type I_Type II_Unlisted_
~Coordination:(date sent)
~ L WRP Consistency Assessment Form
~ CAC Referral Sent:
~Date ofInspection:
~Receipt ofCAC Report:
_Lead Agency Determination:_
~Technical Review:
~Public Hearing Held:
Resolution:
~ E A~R ~: :00 E ~
Soutl1hold Town
Board of Trustees
S+tv<.
Vi..c)"""" Vlce.,..~; \,II ..
Phone Number:(~t
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Name of Applicant
11 j4; 16.,..,(1.. ~t.
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Property Location:_\lI'~>,-"P Vie..., ~i "', 1f.---El((tJr" A~...,c...
k.. C\J~ck>}'f, ~ ur.o,..} Iw."t .....
(provide LILCO Pole #, distance to cross streets, and location)
Address
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Suffolk County Tax Map Number: 1000-
('D'l
AGENT:
(If applicable)
-
Address:
Phone:
Board of Trustees Application
GENERAL DATA
Land Area (in square feet):
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be. cAe, 1 V;l't )J'
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Area Zoning:
Previous use of property:
Intended use of property:
--fW~
Covenants and Restrictions:
If "Yes", please provide copy.
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. J-No Ci'out ~ ~ ~MW 1\..)
Yes
Prior permits/approvals for site improvements:
Agency
Date
/NO prior permits/approvals for site improvements,
Has any permit/approval ever been revoked or suspen~ by a governmental agency?
/ No Yes
--
If yes, provide explanation:
Project Description (use attachments ifnecessary): '
? ~ 4 ' -.os ~,..{.~ ,f. 4d. "t.,-o L~c1c l~~' 1-
~. .P ~ Ii 1ft ~ fk,J;A '.., - M1<IUVC-
-'~, i w, t. tt . - e..J f'-A-~ lC.r't. Ji"-ot.. ~ ~,.;Ia.;...A
f6~ ~ ~~~ <-{ ~ ~~ L,AII.u~ ;,;t.
J l...tJ..J. {.(ee ~ ~w ~i'w ~~ -lwei) ~~I(J 4f~
~.....1\ ~'''C S~"'\I(,J'" +~..
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:--1 ~,..J J~ ~ ~
-fIt,o V ',J.M.) ~ J rAft" -(.0 .t rtc.A. ~ web ~
.J.tL fvt"'" ~ l,;~ 0 ~ ~c.,..f r, .D.. ( 1 ~ k.~
tJ~~1I
Area of wetlands on lot:
square feet
Percent coverage oflot:
"
%
Closest distance between percest existing structure and upland
edge ofwetlands:J ...~ Uw" feet .
Closest distance between nearest proposed structure and upland
edge of wetlands: __ feet
Yes
--t<-t
J ~~(Q tloS..s't.~ ~ ~
t.,t\A\...)~~~ I' )u:I
~ ,....,,( CIA- .
cubic yards
Does the project involve excavation or filling?
Y No
If yes, how much material will be excavated?
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:
-----_._--._-~-------_._---_.- --------
Statementofthe effect, if any, on the wetlands and tidal waters of the town thatnlaY result by
reason of such proposed operations (use attachments if appropriate): .. _n - ...
1~ ~~fA k ,"- ~'(H'f.lflll,j-.lj ()t..I ~
-;1-J I't+~. J ""+ ~JJ /,~. ~ ..f, loof
4-.. (J ~IJ" w. C..J I/IM-N 1t> .f(. eft w... . (" -fa ~/
"J.. 0.-.1 ~ +- J) cJ., 1 +-t. ( ~. d f..,o J...Q I, t
piAKJ .... ust J;rA + r~ vJ ~ -j1A. N~tv
~v" ..
PROJECT 10 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)
SEQR
PART 1. PROJECT INFORMATION
1. APPLICANT I SPONSOr J
\JCr \..v' ~
3.PROJECT LOCATION:
C~~J4A
Municipality
2. PROJECT NAME
,Jj
I) (Ie.
~
County
SIi>
4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ete - or provide map
5. IS PROPOSED ACTION:
~ ""oP!
O..J) "1 ~ '
J ~\.J.q \. (t..;. ~"" ~ ~, ~,,1 k" ~~ J~
k --.J ~Ao I r ~4\d.J ""I~t (J.,J ~ ~ ~ of
~ ~ J..JUJ C. ~#.J .s~'" 4& rtr ~U~
~'J '+D J'lt4 It--A ~/",. CN1 J;cb1/o+ ~t.H'11f11f'-., ko
J",+ ~ -t .I', J..,. J
New
D Expansion
D Modification / alteration
..
~
~
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT F LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes D No If no, describe briefly:
.
9. WHAT IS PRESENT LAND USE IN VICINITY
~eSjdential D Industrial 0 Commercial
bUt
OF PROJECT? (Choose as many as apply.)
DAgricu,ture D Park I Forest I Open Space
D Other (describe)
J
p,... ..ft... ( .-t
10. DOES ACTION
AGENCY (Federal
DYes
INVOLVE A PERMIT APPROVAL. OR FUNDING,
ate or Local)
If yes, list agency name and permit I approval:
NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
rr:-DOES~~Cl OFIRFACTTUN HAVE"f\: CUKRENT[V VAliD PERMJ. OR
D Yes No If yes, list agency name and permit I approval:
APPROVAL ?-
12. AS A R PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
[]ves
CERTIFY HAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I Sponsor Na e
Signature
t ~l,) \
Date:
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 comoleted 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 617.6? 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~wrjtten, 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:
L .~._". . .-- n~~_ J
CZ. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
r : 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 briefly:
I J
C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly:
I u. - 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 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)? Jlf yes, explain briefly I
DYes 0 No I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain:
DYes ONo 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,-t-he ~Ra-tiQn-Gt--sj9Aific3nGe ml:Jctevaluate-the potential-tnwaet-ef-tn6-f)fep€>seG-ectieFt--eA-#te eFl y iroflfl,t,nta-l--ehat-aeteristfesoHheGE-A-:--
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,
Check fhis boxlf you have--determTned, based on the information and analysis above and any supporting documentation, that the proposed actiol
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)
.
"
Board of Trustees Application
County of Suffolk
State of New York
· . , "~ 4t1Z <l (izL' BEING DULY SWORN
DEPOSES AND AFF STAT HE/SHE IS THE APPLICANT 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 IN THIS APPLICATION AND AS MAY
BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT
AGREES TO HOLD THE TOWN OF SOUTH OLD 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, THEIR AGENT(S) OR
REPRESENT ATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE
PREMISES IN CONnlNCnON WITII RE~W OF TIllS APPUCA TlON
t; ~?Iv~
Signature
SWORN TO BEFORE ME THIS
l+~
DAY OF t\r,,-~__,20 0 8.
N''''~ "-~
~~f'~yJ~8~[lc, State of New York
No 01 JU6059400
Qualified In Suffolk County I ,
Commission Expires May 29, 20...l.l...
.
Board of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
.
.-
I,
(print owner of property)
residing at
(mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(Owner's signature)
8
.
APPLlCANT/AGENTIREPRESENTATlVE
TRANSACTIONAL DISCLOSURE FORM
The Town of South old's Code of Ethics orohibits conflicts of interest on the Dart of town officers and emD.avees. The Dumose of
this fonn is to rovide information which can le t e town of ible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME:
toW
(Last name, first name, J11iddte initial, unless you are applying in the name of
someone else Of other entity, such as a company. lfso, indicate the other
person's or company's name,) ,
1.. ~;~
NAME OF APPLICA nON: (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 YOll 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
v--
If you answered "YES", complete the balance of this fonn 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 oflicer or employee or his or her spouse, sibling, parent, o'r 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 omcer, director, partner, Of employee of the applicant; or
_D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS ]
S~bmitted this ~ A~"it.~ 200 J
S tgnature . ~ ,-" "-
Print Name )'t {y ~
'/),L , fA'C
. .
.
Albert J. Krupski, President
James King, Vice-President
Artie Foster
Ken Poliwoda
Peggy A. Dickerson
BOARD OF TOWN TRUSTEES
TO\VN OF SOUTHOLD
Town HaIl
53095 Route 25
P.O. Box 1179
Southold, New York 11971-0959
Telephone (631) 765-1892
Fax (631) 765-1366
OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO
N.Y.S. Dept. of Environmental Conservation (DEC)
SUNY, Bldg. 40
Stony Brook, NY 11790-2356
(631) 444-0355
Mon., Wed, Fri., 8:00 AM-3:00 PM
Suffolk County Dept. of Health Services
County Center
Rivcrhead, NY 11901
852-2100
U.S. Anny Corp. of Engineers
New York District
26 Federal Plaza
New York, NY 10278
212-264-3912
N.Y.S. Dept. of State
Coastal Management
162 Washington Ave.
A.lbany,l'JY__12231_______ .
518-474-6000
.
James F. King, President
Jill M. Doherty, Vice-President
Peggy A. Dickerson
Dave Bergen
Bob Gnusio, 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 ApplicatioV"
_ WetIand Permit Application L Administrative Permit
~. _Amendment/Trans er/ . xtension
eceived Application: '1 7 ~tJ
ReceivedFee:$~
~ompleted Application~
_Incomplete
_SEQRA Classification:
Type I_Type II_Unlisted_
Coordination:( date sent)
""7 L WRP Consistency Assessment Form ~l Co...
CAC Referral Sent:
::::::-nate oflnspection:~\aX
_Receipt ofCAC Report:
_Lead Agency Determination:~
Technical Review:
-Pblic HearingHe~
_Resolution: .~.~
Office Use Only
'fBJ ~ ~ ~ 0 W ~ lf11
IflJI APR - 7 2008 ~,
Southhold Town
Board of Trustees
~\,jf:.
s+~
1I,,,c ~.) 1-1 Cc... "": "" ,
Phone Number:(~t
11 j4;I(,.~ ~r.
~.:1'f ~fDV
,
Property Location:_\lI'~~ Vie"", \-\i IIC', ""_fh'(tA. ~~...,(..
k.. C\J~~, ~ uGoHl ~~r- .t......
(provide LILCO Pole #, distance to cross streets, and location)
Name of Applicant
Address
C~~J~
Suffolk County Tax Map Number: 1000-
('02.
AGENT:
(If applicable)
-
Address:
Phone:
~rd of Trustees APPlicati~
GENERAL DATA
Land Area (in square feet): t (t,.,L (IT
Area Zoning: I\.e'.) i 4"...+,...1 .
-f'A~
<<t.......st"
be.Jc. 1 VI'M.~
J ~i (~ < ~1#'tI 0,.. 1"4-
).. ';/P"" ~,) 0 .
~No (I'vt ~ ~ lc:./.d)W 1\.)
Previous use of property:
Intended use of property:
Covenants and Restrictions:_ Yes
If "Yes", please provide copy.
Prior permits/approvals for site improvements:
Agency
Date
/NO prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspen~ by a governmental agency?
/ No Yes
--
If yes, provide explanation:
Project Description (use attachments if necessary):
? ~ 4" ~s 1v -rI.. ,f..w.. "'-0 LLtA ~.(~
~. .J woJ.J Ii (ft -\., rk,J ~ ....... - M~IA:....
~ i fA), c,. ft. - e.-A t-A-t I~t. J,\.ot.. ~ ~1.;fz..)N.,J
fIJ'I ~ Cu"~ (...(~ ~ L,AI i.J~ :,;,..
J .....J.J ll(ct ~ VlAAw ~r~ ~~.JwJ;/ h,.~(tJ .~
~.....i\ ~i"r s~~vt,.s.... +-~"
4Ifard of Trustees APPlicat~
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:~~,...J J~~ ~
--fJa.ov"~) #YJtAR.t,,-(r, .krtc.t... *:s vdl ~
~ Ivt"" ~ l.I'<' 0 11'1 t:C,,-f /', ~ ( ~ ~ k.~
II ~ b..1l
Area of wetlands on lot:
square feet
Percent coverage oflot:
I'
%
Closest distance between neifest existing structure and upland
edge ofwetlands:J "'~rUw" feet
Closest distance between nearest proposed structure and upland
edge of wetlands: -- feet
Yes
~
J t;Q,,(Q ~os.s\4~ ~ ~
t~\A'''')~~~ to r-
~ ~((DA- .
cubic yards
Does the project involve excavation or filling?
Y No
If yes, how much material will be excavated?
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:
Statement of the effect, if any, on the wetlands and tidal waters ofthe town that may result by
reason of sudi proposed operations (use attachnlents if' appropnate): - - - - -- -- - - -
1 ~ l., 7 U k 1"- fr". yWf .MIl J-..u OIJ ~
<;' -h J'I +~. J ",..\- ~J..J ~,. ~ -h IO()f
~ (J ~,,~ w. c J tAAt~ 1t> 11. <:I, tcJ... ,.1" -fa t~ ~".r
"J.. 0 ~ ......, +- J) d, 1 -rc.. ( .rt-. d ~J..Q tI. r
p,AltJ .N u.,St ..r"rk. + r~ vi ~ --('&. Nt''''
~v" ~
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)
.
SEQR
PART 1 - PROJECT INFORMATION
1 APPLICANT I S:~OL r 0/...
3.PROJECT LOCATION:
C I.>~ Jl.A.
Municipality
2. PROJECT NAME
,~
~{Ic.
..
County
s"
4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landmarks ate - or provide map
~,.J
~
~'J ,tl:>
~ ""JI
( ,...J) c..f ~ '
J ~I..~ \;(t..-f. ~"" ~~, eu~ "'\Jc.~\Iof...~
c.o..;t"" I r ~~J ~i'f~t ~,.J., ~ ~ ~ -+
~ . J ~, ~'" JtMA,., ~ -rtr e.ou~
J'It.c.. *,....). "/0,. eN 1 J,J, 1 I 0+ ~ c.H' 1 NfI.v
j",+ ~ -t .J",.t. J
D Expansion
D Modification I alteration
..
~
5. IS PROPOSED ACTION:
6. DESCRIBE PROJECT BRIEFLY:
7. AMOUNT F LAND AFFECTED:
Initially acres Ultimately acres
8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
l2fves 0 No If no, describe briefly:
.
9. WHAT IS PRESENT LAND USE IN VICINITY
~eSidential D Industrial 0 Commercial
J 1;\)(
OF PROJECT? (Choose as many as apply.)
OAgriculture D Park / Forest / Open Space
OOther (describe)
"Iw ~ ( .-t
10. DOES ACTION
AGENCY (Federal
DYes
INVOLVE A PERMIT APPROVAL, OR FUNDING,
ate or Local)
If yes, list agency name and permit I approval:
NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
n. DOES
DYes
Y VALID PERMf-r OR APPROVAL 1
o If yes, list agency name and permit I approval:
12. AS A R
Ges
LT OF PROPOSED ACTION WILL EXISTING PERMIT I APPROVAL REQUIRE MODIFICATION?
No
CERTIFY HAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
Applicant I Sponsor Na e
Signature
Date:
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 comDleted by Lead Agency)
A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 617.4? II yes, coordinale Ihe review process and use Ihe 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 negalive
declaration may be superseded by another involved agency.
o Ves 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,
rlenlial lor erosion, drainage or nooding problems? Explain brieny:
C2. Aesthetic, agricultural, archaeological, historic, or other natural or cultural resources; or community or neighborhood character? Explain briefly:
L
C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly:
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
C5. rowth' subsequenl development, or related aclivities likely to be induced by the proposed action? Explain brieny:
C6. long term, short term, cumulative, or other effects not identified in C1-C5? Explain briefly:
I
C7. rr impacts (inctudingchanges in use of either quantityor type a/energy? Explaon brienv_
...
I
I
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:
o Ves 0 No I I
E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain
OVes ONol ..j
PART 1II. DETERMINATION OF SIGNIFICANCE (To be compleled 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
ye€, the 9gt9fmin3tion ofeiQniftcanGe mustevall:late-tAe-petefltial-impact aftRe proposea setioA 0F1 tRt; cflvirOflfficfltal charactertsties-oHn-e-6CA.
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.
Checklhls"i:ioxlfyouhaviidetermTried-, based-on the Infor-matian and imalysls -above and" any supporting documentatfon,-fh-iifihe proposed actio
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 Responsrble 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
.' .. ''M:< duz li l,Y BEING DULY SWORN
DEPOSES AND AFF STAT HE/SHE IS THE APPLICANT 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 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 RE W OF THIS APPLICATION.
.Lv~
SWORN TO BEFORE ME THIS
1+1,.
DAYOF~(\.:r I
,20~
NO~~
~<g'+,~y J~32r,c, Stata 01 Naw York
No 01 JU6059400
Qualified In Suff~lk County .iL
Commission Expires May 29, 20
.
.
APPLICANT/AGENT/REPRESENtATlVE
TRANSACTIONAL DISCLOSURE FORM
The Town ofSouthold~s Code of Ethics orohibits conflicts of interest on the Dart arroW" officers and emolovees. The OUfDOse of
thi form i 0 rovide information w ich can ale e town of ssible conflicts of interest and anow it to e whatev act! n is
necessarY to avoid same.
YOUR NAME:
~
(Last name. first name.-Q1iddle 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.)
1.. ~; ck....
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
v--
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 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% ofthe shares of the corporate stock of the applicant
(when the applicant is a corporation);
B) the legal or "beneficial owner afany 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
SUbmittedthis~ Jl~4;' '" 200J
Signature . ~ l,." --
Print Name .)1:. (y I
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June 25, 2007
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P.O. Box 985
Cutchogue, NY
11935
734 5904
To Board of Town Trustees
Town Hall
53095 Route 25
P.O. Box 1179
Southold, NY
11971-0959
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SOlllhold Town
Board of Truste~s
Re: Dist 1000 Sect 103 Block 1 PCL p/o 19
Dear Trustees:
I am writing to ask about our lot on Vineyard View Drive off
Stillwater A venue. I have enclosed our survey from when we built the house
in the mid- 1 980s, along with the subdivision map itself.
As you can see on the survey, the surveyor back then wrote 'wetlands'
on the map. I believe from looking at the DEC wetlands map in your office
that the actual wetlands of Eugene's Creek is several hundred yards farther
down from our property.
The rear line of our property is a vector control ditch maintained by
Suffolk County. Phragmites has grown in that ditch; this is the reason I
believe the surveyor wrote 'wetlands' on our survey. I don't believe this
ditch is part of the meadow of Eugene's Creek, but I need your office to
clear that up for us. Every few years the county sends a bulldozer down this
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ditch, knocking down all the phragmites, which creates a real mess on the
back of our property.
I would like your assistance in clearing up the wetlands question on
our lot. I ask because I would like to do work on our house - to, for
example, tear down the 27-year-old deck behind the house and replace it as
well as extend it farther from the house, to build a stone wall along the slope
of the property, and also to replace leaking windows on the back of the
house.
But also because I want to plant some trees or do something along the
back property line to both screen us from the ditch and the mess the
bulldozer makes when the county cleans it out.
Could you please clear this up for us and let us know what we can do
within our property lines?
Sci;'1uJ
stJl Wick
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APR - 7 2008
, $oulbho\cl Towa
Board of TJ\lsbleS
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RODERICK VAN TUYL, P.C.
L1!t.~t;::;J~ORS
GftEENPORT NEW YORK
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'),1< CO HEALTH DEPT. APPROVAL
H.S NO. i4-S().23i
ST ATEMENT OFI~Ij:I\I;{ .
THE WATER SUf'I.PL Y AN0 S~4~ii.:~AL
SYSTEMS FOR THIS ~~~~. -\!i"LL
CONFORM TO THE STANDARDS OF THE
SUFFOLK CO. DEPT. OF HEALTH SERV1~,
(5)
APPLICANT
SUFFOLK COUNTY
SERVICES - FOR
CONSTRUCTION ONL Y
DATE:
H.S.REF.NO.. /--1-50.281
APPROVED:
DEPT. OF HEALTH
APPROV AL OF
SUFFOLK CO. TAX MAP DESIGNATION:
pIST. SECT BLOCK PCL.
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OWNERS ADDRESS
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DEED: L. 7::;"/0
TEST HOLE
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to th!$ survey is ;'} violetioo-'Q1'
~lon 1200 of the NewV~< 0,_.",
~.ucation Lew; . "',,'_'_"'C
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and surveyor's ink;x! SB;.;!
embossed seal sh~1l nu1 b~
to b8 II valid true copy:
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o thG J)6f'9on fOr who."" .th.. =" ,.' __--'....'
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tit:::ed. and on his bOO<<lt,tt) tlls
lendi ,pe~Y. ~overnmem:<;f H~e'lq':q\d
ng m:n,tutU)fJ listed her.;-c;;1 "'nd- -
to ~he eeslgnees of the landing insd;
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