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Home My WebLink AboutTR-7006AJill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DAT~c INSPECTION: V' Ch. 275 Ch. 111 INSPECTION SCHEDULE INSPECTED BY: COMMENTS: __ Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction ~ constructed __ Project complete, compliance inspection. ob- CERTIFICATE OF COMPLIANCE: 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 SOUTI-IOLD 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 1st day of construction ½ constructed Project complete, compliance inspection. [,'d 8896-~)0~- I, g9 Je!JJeq°°3 d~g:SO 0 ~, 6 i, James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghos±o, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1692 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 1st day of construction ~ constructed Project complete, compliance inspection. James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall Annex 54375 Main Road 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.: 7006A Date of Receipt of Application: November 7, 2008 Applicant: Diane Gregory SCTM#: 78-7-11 Project Location: 735 Waterview Drive, Southold Date of Resolution/Issuance: December 10, 2008 Date of Expiration: December 10, 2010 Reviewed by: David Bergen, Trustee Project Description: To hand-trim the phragmites to 12" in height. 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 Diane Gregory, received on November 7, 2008. 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. JaYmes F.~ing, P~esident 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 Please be advised that your application dated /f~o~ ~, c~OO~r' has been reviewed by this Board at the regular meeting of ~.¢,~,~--/o. o~p ~ and your application has been approved pending the completion of th~ 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) __ ¼ 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: TOTAL FEES DUE: $ .~,) ~ BY: James F. King, President Board of Trustees James F. King, President Jill M. Dohe~, Vice-Presid~nt Peggy A. Diekerson Dave Bergen Bob Ghosio, Jr. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765 - 1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: /, Z./~-/Oo__~ ~('. 3c.~A'~._ DIANE GREGORY requests an Administrative Permit to hand-trim the phragmites to 12". Located: 735 Waterview Dr., Southold. SCTM#78-7-11 Type of area to be impacted: .~Saltwater Wetland __Freshwater Wetland Distance of proposed work to edge of wetland ~ ,~<-~ Part of Town Code proposed work falls under: ~._Chapt.275 Chapt. 111 other Sound __Bay Type of Application: __ Wetland __Coastal Erosion __Amendment ~'--Ad minist rative__E mergency __Pre-Submission Violation Info needed: Modifications: Present Were: __&King __J.Doherty__P.Dickerson . __ D. Dzenkowski Mark Terry__other Form fille4 out in th.e field by · Mailed/Faxed to: Date: ~-..D. Bergen__ B.Ghosio, Environmental Technician Review- James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, 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 SOUTtIOLD Office Use Only Coastal Erosion Perrrdt Application --Wetland Permit Application ~Administrative Permit R Amendment/Trans fqr/E~te.n.~,ion Rece~vved Application: eceived Fee:$ ..~t~ ! /Completed Application __Incomplete SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent). __LWRP Consistency Assessment Form __CAC Referral Sent: ~.~-Date o f Inspection: __Receipt of CAC RepOrt: ' ' __Lead Agency Determination: __Technical Review: ~ublic Hearing Held: __Resolution: Name of Applicant Address ?:t 6 Mane Phone Number:(b*l) ?(~5- ! ~ ~'~> Suffolk County Tax Map Number: 1000 - Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: ~rd of Trustees App Land Area (in square feet): Area Zoning: ~ GENERAL DATA Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes ~F 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? V' No Yes If yes, provide explanation: Project Description (use attachments if necessary): I }ard of Trustees Applicat~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purposeoftheproposedoperations: ~[1.{- ?hraqr, _ t s Area of wetlands on lot: ~. 5 square feet Percent coverage of 1ot:~,..~2_~% Closest distance between nearest existing structure and upland edge of wetlands: } [ q feet Closest distance between nearest proposed structure and upland edge of wetlands: Iq I fl feet Does the project involve excavation or filling? ~ No Yes If yes, how much material will be excavated'? ~11~ cubic yards }Iow ranch material wilt be filled? .~3[! cubic yards Depth of which material will be removed or deposited: O}A Proposed slope throughout the area of operations: ~/fl Manner in which material will be removed or deposited: .,,~ ~ .. feet Statement of the. effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use aita~hments if appr0Priate~i PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1APPLICANT/SPONSOR 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 County 1~, ~..~-~ t~ SEQR 3 PROJECT LOCATION: Municipality ~0 ~.'~'~ 0 ~ ~1 4 PRECISE LOCATION: S~reet Addess and Road Intersections. Prominent landmarks etc- or provide mad 5. IS PROPOSED ACTION: [] New [] Expansion E~odification / alteration 6 DESCRIBE PROJECT BRIEFLY: /-o Io 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~-~Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) E~]Residential [~Industrlal ~Commercial [~Agdculture E~Park/Forest/OpenSpace E~]Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) E~Yes [~o if yes, list name and / permit -- --'f'T] DOES ANY A~PECT OF TFfE ACTION HA~E A CUF~I~c'~TL~/ VALID PERMIT OR APPROVAL? - ' ' ~]Yes [~No If yes, list name and permit / I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date; 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 A~lenc¥) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD iN 6 NYCRR, PART 617.47 If yes, coordinate the review process and use the FULL EAF. r~Yes E~]No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617~67 If No, a negative dec[aration may be superseded by another involved agency, E~Yes E]No ;. 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 traific pattern, solid waste production or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other natural or cuflural 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 commun iy's ex s ng pans or goals as officially adopted, or a change in use or intensib/et use of land or other natural resources? Explain briefly: C5 Growth, subsequent development, or related activities likely o be nduced by he proposed ac on'~ Explati~ briefly: Long term, short term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7 Other impacts (including changes in use of either quantity or type et energy? Explain briefly! D WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA (CEA ? lit es, ex lain brief] : E IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? if yes explain: Fl es [Z]No PART Ill - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~ve~determinewhetheritissubstantia~~large~imp~rtant~r~therwisesigni~cant. Each effect should be assessed in connection with its (e) 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. dete~m~etio n 9hsiG~ificartce must evaluate the petentialimpa ct c f the pre poeed-aetion on the e nviron, m c n ta~ character~$t~c~of the 6EA. Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl. EAF and/or prepare a positive declaration. Check this b~x ifye~ h~ve deiermin~d, b~sed on the information and analysis above and any supporting document~ti0nl that ~l~rop~seci actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding thi." determination. Name of Lead Agency Date Tibe of Responsible Officer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Board of Trustees Application County of Suffolk State of New York bl~'Lt~ ~ 0:r!C~'CI 0('[ .,~ BE1NGDULY SWORN DEPOSES ANT) AFFIRMS THA~I' HE/~HE 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 WmL BE DONE FN 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 REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REVIEW OF THiS APPLICATION. SWORN TOBEFORE' ME TI-lIS' SignatUre' {/ -- DAY OF ~ ,20 0 ~ Notary Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics vmhibits conflicts of interest on the part of town officers and employees, The purpose of this form is to provide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is YOURNAME: 6 1'(2_35t0C {~ , ~>t~_IQO ~ , (Last name, first nathe, [niddfe 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,) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other", name the activity.) Do you personally (or through your compm~y, spouse, sibling, parent, or child) have a relationship with m~y officer or employee of the Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Business interest'? ~neans a business, including a partnership, in which the town officer or employce has even a partial ownership of(or employment by) a corporation in which the town officer or employee or, ns more than 5% of the shares. YES NO v/ lfyou answered "YES", complete the balance or'this £orm and 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 applicanffagenffrepresentative) and the to~vn officer or employee. Either check the appropriate line A) through D) and/or &scribe in tile 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 applicoJ~t is a corporation); B) the legal or beneficial owner 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 Submitted this day of t4OV~.t¥O:~.4' 200 2~ Signature ~t},.{Rtl b~Id..tOO~'h?~e j-- PrintName DfbfL~ Y.-. OM'CJOtOt-~t'~ .ol- NE~ N.Y.S. Lin. No, 49668 A. Ingegno Land Surveyor PHON6 (651)727-2090 Fex (631)727-1727 NOTES: 1. ELEVATIONS ARE REFERENCED TO N.G.V.D. 1929 DATUM EXISTING ELEVATIONS ARE SHOWN THUS:~0 EXISTING CONTOUR LINES ARE SHOWN THUS: - 5-- 2. ANY WETLAND BOUNDARIES SHOWN ARE SUBJECT TO VERIFICATION BY NEW YORK STATE AND/OR OTHER REGULATORY AGENCIES. SURVEY OF PROPERTY SITUA TED A T SOUTHOLD TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK S.C. TAX No. 1000-78-07-11 SCALE 1"=20' MAY 5, 2006 AREA 26,759.B8 sq. ff. (TO T~E UN£) 0.614 ac. ' ' 26-13u