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Home My WebLink AboutTR-7009ATOWN OF SOUTHOLD SUFFOLK COUNTY, N. K 1000 - 56 - 04 - 17 Scale I." = 20' Dec~ 2,.3, 200:.5 JULY 27, 2006t - Board of ~ j C£RTIFIED TO' BANK OF AMffRICA CAM~RID~ TITLE AGI~IV~Y N~D It'. Z MARY ANNE HARROC~V James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hail Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Permit No.: 7009A Date of Receipt of Application: December 8, 2008 Applicant: Ned Harroun SCTM#: 56-4-17 Project Location: 63745 Route 25, Southold Date of Resolution/Issuance: December 10, 2008 Date of Expiration: December 10, 2010 Reviewed by: Board of Trustees Project Description: To remove a large dead willow tree located on the west side of the property and grind down the resulting stump. 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 Ned Harmun, received on December 8, 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. James F. King, lent 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 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. K/ng, 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 SOUTHOLD Office Use Only __Coastal Erosion Permit Application/ __Wetland Permit Application o,,~ Adminls~-afive Permit Amendment/Transfer/Extension ~e-~vved Application: 7 ~.~ R'~eived Fee:$ ~--~ompleted Application Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent). __LWRP Consistency~Assessment Form __CAC Referral Sent:~.. . ~ate of Inspection: __Receipt of CAC Report:v ~Lead Agency Detemnnation: Technical Review: ~.~_A~ublic Hearing Held: Resolution: Name of Applicant Address {07)-[1~ ~ RO~ 2.6 i ._C-Ol Dflno.~. Phone Number:( )(obi -2q I-I]00 Suffolk County Tax Map Number: 1000- 5{0. q - 17 Property Location: 501 k/qO.~3C OJ~'' ~{~1 CX~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Applicati Land Area (in square feet): Area Zoning: Previous use ofproperty: Intended use of property: GENERAL DATA Covenants and Restrictions: Yes No 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 suspenCed by a governmental agency? VNo Yes If yes, provide explanation: Project Description (use attachments if necessary): % I- 1' ioco r on esk s d.c Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Area of wetlands on lot: ~,'91q 1~ squTM feet Percent coverage of lot: 0 % 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? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect, if any, on the wetlands and tidal waters of the town that ma~ result by mason of Sudfi'~bpo~cf PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1.APPLICANT/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) SEQE 3,PROJECT LOCATION: County Municipality %'~'~1 ~ PRECISE LOCATION: Street Addess and Road Intersecgons. Prominent landmarks etc -or provide map 5. IS PROPOSED ACTION: E] 'New E~ Expansion [~Modiflcation / alteration j. 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. 'WI L 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 E~ Industrial [~Commercial r~Agriculture E] Park / Foresl / Open Space ~Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Fe..~al, State or Local) ]Yes L~JNo If yes, list name and permit / agency approval: ]].uub;5 ANY~'Ft;fJI O~'lHb ACRON HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E]Yes Iv~No If yes, list agency name and permit / approval: 12. ASA ~NoL E~Yes RE LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE App]icant/ 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 Agency) 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. ~] Yes [--']No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACT]ONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. r-]Yes ~']No C. COULD ACTION RESULT iN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: Answers may be han~lwrflten, feg ble) 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: C2. Aesthetic. agricultural, archaeological, historic, or other natural or cultural resources; or cemmunity or neighborhood character? Explain briefly: C ge a on or fauna fish shellfish or wildlife specles_s~g~!fl(!_anl hab,ta~s~ or threalened or endangered species? Explain briefly C4. A communily's existing plans or goals as o~ficially adopted, or a change in use or inte?~!? et use of land or other natural resoumes? Explain briefly: C5. Grow[h, subsequent development or r;iated ac[!!!!!es likely robe induced by he p oposed CE. Long term, shorl terffi, cumulative, or o her effec s not identifieO in C1-C57 ~xplath hdetly: C7 ~!~r !rn~ac!? !!nclud!n? ~S !n u~? ~[ ~!!her qu?tib/ or type of energy? Explain / D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL[~Yes E~N°AREA"' (CEAI ? ~lf ;/es, explain bdefl~: I E. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL iMPACTS? f }.es exp a n: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine wheiher it is substantial, large, important or otherwise significanl. 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 (~ magnitude. If necessary, add attachments or reference supporting materiats. Ensure that explanations contain sufficient detail to show that ail relevant adverse impacts have been identified and adequately addressed. If question d of part JJ WaS checked yes, the determ!n=!!on cf c!gn!.c,,c_.?.nce muct~vs~us.'c thc peter~liaHmffeetof4h c prcpcocd ~',cfic s ca thc, ~r, vl;c.~,~.,cnt~l c.~. oct~r',st[~ of li-,e CEA. Check this box if you have identified one or more potentially la rge or significant adverse impacts which MAY occur. Then proceed directly to the FULI EAF and/or prepare a positive declaration. ~e~;[ ~ffi~ ~-~ ~-v~ ~ ~i~-n n~n~J': b~a o~[1~-i~fi~m~tion and ~naly~is ~b(~ve and a~y ~u~po~1 n~ (~ (~c~ ni~[~'~i t-I~ {i~i'o~-~ ~ ~ a ~ c tio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessarj, the reasons suppoding thi determination. Name of Lead Agency Date Title of Responsible Officer Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signalure el Preparer (If differenl from responsible officer) of Trustees Applica~n County of Suffolk State of New York 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 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 REPRESENTATIVES(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH REV1EW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS ~ DAY OF ]~e. ,2o ~ Notary Public LAUREN Mm SIANDISH Notary Public, State of New York No. 01ST6164008 (]ual fled in Suffolk County Commission Expires Ai)fi 9, 20j,t_ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the oart of town Officers and employees. The purpoSe of thi~ form is to omvide information which can alert the town of ~ossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, firsi namd, ¢iddle inltihl~ un'le~s yod ar~ ap[lying 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 activity0 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 interesff 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% oftbe shares. YES NO V lfy0u answered "YES", complete the balance of this form 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 applican'dagenffrepresentative) 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 ( w hea/h e~app licant 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) thc actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Submitted this Signature Print Name __.day of 200