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Home My WebLink AboutTR-7060A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: r,/~ Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ',/2 constructed ~roject complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: 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.: 7060A Date of Receipt of Application: March 18, 2009 Applicant: Deborah Doty SCTM#: 103-13-5.3 Project Location: 670 West Creek Ave., Cutchogue Date of Resolution/Issuance: April 22, 2009 Date of Expiration: April 22, 2011 Reviewed by: Trustee Dave Bergen Project Description: To remove a diseased tree adjacent to the wetlands, with the stump cut to grade. 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 received on March 18, 2009. Inspections: None 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. Board of Trustees James F. King. President Jill M. Doherly. Vice-President Peggy A. Dickel~on Dave Bergen Bob Ghosio, Jr. PO Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631 ) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: DEBORAH DOTY requests an Administrative Permit to remove a diseased tree adjacent to the wetlands, with the stump cut to grade. Located: 670 West Creek Ave., Cutchogue. SCTM#103-13-5.3 ~eof area to be impacted: altwater 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 ministrative__Emergency Pre-Submission Violation Info needed: Modifications: Present Were: __J.King __J.Doherty __P.Dickerson ?~_D. Bergen__ B.Ghosio, __ D. Dzenkowski Mark Terry__other Form filled out~ the field by Mailed/Faxed to: Date: Environmental Technician Review- · ~ View u~os~: ~lvo~ Mooring S S~uo~: ~ho~e To~n: . ~ ~ ,-, Cross Section 5c~1~: I"=20' ~ Proposed Fixed Walk Fiberglass Grid Material U~rnl~: OF T~dOl cantalevered 2" ¢~uaro openings o~ d¢lln¢obCd~R. Fox ~,~1~ ] ~ ~ L,¢ ~akelia¢ 4 x~O (min. 1.5 a~.er.) ~o'+ ~ opposite 2~" pvc pipes ~ ...................... : b,;m. Grid Pane f ¢ ; Po~ i ', ~ ~ ~The app cant requests permission to mod~ the ramp by re-using material used IS~ L~ELfor construction of the ramp and creating 3 steps to grade. No change to the IMAm)lNG overa Ongth or width is proposed ~ ' f '~ t · I~, - ~v-, ~. ~ TMf5 PLOT ~ ~LOeED 03/~7/2009 ~4:47 -734-7702 [E:~ORAH $ ES~ PAGE 87 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 SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension JRece]-vvedApplication: .~ ]19 ~ ,-~IYeceived Fee:$ DQ.~ ~ · -4~mpletedApplication ~]l¥]0c} Incomplete SEQRA Classification: Type I Type II Unlisted Coordination:(date sent) __LWRP Consistency Assessment Form __CACReferral Sent: ri __Date of Inspection~'~4.~~ __Receipt of CAC Rep~rt~ ~ __Lead Agency Determination: Technical Review: Hearing Held: 3ii,jo~} __Resolution: MAR 18 2009 I tS?'t Suffolk County Tax Map Number: 1000 - IC~_'~' - ! '~ - ~'. 3 Property Location: ~z, 7~ ~ f---~.~l~-- . ,j~,,',, (~'~-.~,,~... (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: Board of Trustees Ap~ Land Area (in square feet): Area Zoning: Previous use of property: Intended use of property: GENERAL DATA Covenants and Restrictions: If "Yes", please provide copy. Yes X' 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 if necessary): t~c~,~-~) ~ Board of Trustees Applieion WETLAND/TRUSTEE LANDS APPLICATION DATA $ Area of wetlands on lot: .square feet ~_~_ Percent coverage of lot: % ~'~._ . ~x_,a -~ ,-~ ,.~...~ Closest distance between nearest existing structure and upland edge of wetlands: !t~,>-'r t feet Closest distance between nearest proposed structure and upland edge of wetlands: ix4/or 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: tx/tk- Manner in which material will be removed or deposited: r~~,~ S~atement olive effec[~ if any, on the wetlands and tidal waters of the town that may_ result by reason of such proposed oi~6mti~n~ (us~ ~tth~hme~s i~h~p~-0priht~i ....... PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: \ Municipality ~CT.~ S~ APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Ap )licant or Project Sponsor) r~2. PROJECT NAME 4. PRECISE LOCATION: Street Addess and Road Intersections. Prominent landm~rkslt etc -or provide map SEQR IS PROPOSED ACTION: [] New [] Expansion []Modification / alteration DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: t't~ V~, ~ ~,a..-0- - . Initially acres Ultimately a~cres 8, W~LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~Yes [] No If no, describe briefly: 9, WHAT IS PRESENT I]AND USE IN VICINITY OF PROJECT? (Choose as many as apply.) ~Residential [~lndustdal I~Commercial r~Agriculture []Park/Forest/OpenSpace r---jOther (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) 11. iJ(Jb~J ANY ASPE(;I OF [Hb ACFION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [--'~Yes [~No If yes. list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? E%s 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 Board of Trustees App~cati,on County of Suffolk State of New York "-"~-~e. e-a_ K_~ BEING DULY SWORN DEPOS~ AND AFFIRMS THAi' 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 1N 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. c. Sig~'~u~re SWORN TO BEFORE ME THIS / 7 DAY OF ~j~'/~' ,20 o~ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM Thc Town of Southold's Code of Ethics orohibits conflicts of interest on thc oari of town Officers and cmolovees. Thc oumose of this form is to erovidc information which can alert the town of oosalblc conflicts of intereSt and allow it to take whatevcr action is necessary ~ avoid same. YOU NAME: (Laser nam-e~ first name, Middle initial, ~tfless you are applying in the name of someone else or other entity, such as a company. If so, indicate thc otl~r 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 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 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 applicanl/agenl/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 o~vncr of greater than 5% of the shares of the co,orate stock of the applic0nt (when the applicant is a corporation); __.B) the legal or 'beneficial owner of any interest in a non-corporate entiky (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