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HomeMy WebLinkAboutTR-7124AJill M. Doherty, President James F. ICing, Vice~President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town HallAnnex 54375M~nRoad P.O. Box 1179 Southold, NewYork 11971-0959 Telephone(631) 765-1892 Fax(631) 765~6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 0535C Date April 26, 2010 THIS CERTIFIES that the 250 sf. impermeable driveway apron At 1600 Grathwohl Rd., New Suffolk Suffolk County Tax Map #117-4-4 Conforms to the application for a Trustees Permit heretofore filed in this office dated 6/17/09 pursuant to which Trustees Wetland Permit #7124A dated 7/22/09 was issued and conforms to all of the requirements and Conditions of the applicable provisions of law. The project for which this certificate is being issued is for the 250 sr. impermeable driveway apron. The certificate is issued to JAMES & MARTHA BAKER owners of the aforesaid property. (/ Authorized Signature Jill M. Doherty, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Brcdcmeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 7654641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: "',/,, Ch. 275 Ch. 111 INSPECTION SCHEDULE __ Pre-construction, hay bale line/silt boom/silt curtain __ 1st day of construction ~ constructed Project complete, compliance inspection. INSPECTED BY: ~ , ~ .~;. ~, COMMENTS: ,,...St 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 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. Deherty, 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 OFTOWNTRUSTEES TOWN OFSOUTHOLD Permit No.: 7124A Date of Receipt of Application: June 17, 2009 Applicant: James & Martha Baker SCTM#: 117-4-4 Project Location: 1600 Grathwohl Road, New Suffolk Date of Resolution/Issuance: July 22, 2009 Date of Expiration: July 22, 2011 Reviewed by: Trustee Jill Doherty, Vice President Project Description: To construct a 250 square foot impermeable driveway apron. 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 James & Martha Baker, received on June 17, 2009. 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. oherty, Vice Pre~/ent Trustees JMD: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 Sout~old, New York 11971-0959 Teleph6ne (6311 765-1892 Fax (6311 765-6641 TO: ~.JOL~e~, BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD been reviewed by this Board at the regular meeting of ~-c,{,, i ?' and your application has been approved pending the com ple(tion 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) __ ¼ Constructed ($50.00) Final InsPection Fee ($50.00) Dock Fees ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of South01d. The fee is computed below according to the schedule of rates as set forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees will be necessary. You will receive your permit upon completion of the above, COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$. ~ BY: James F. King, President Board of Trustees James F. King, President Jill M. Doheriy, Vice-President Peggy A. Dickerson 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 InspectionNVorksession Report JAMES & MARTHA BAKER request an Administrative Permit to construct a 250 sq.ff, permeable driveway apron. Located: 1600 Grathwohl Rd., New Suffolk. SCTM#117-4-4 Type of area to be impacted: J~,altwater Wetland __Freshwater Wetland Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~Gh'~pt.275 __Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion ~t~Administrative__Emergency Pre-Submission __ Sound __Bay ._Amendment Violation Info needed: Modifications: Conditions: Present Were: __&King k/J.Doherty__P.Dickerson __ D. Dzenkowski other Form filled out in the field by D. Bergen__ B.Ghosio, Mailed/Faxed to: Date: Office Use Only __Coastal Erosion Permit Applicati~n~ __Wetland Permit Application L~Administrative Permit  Amendment/Transfer/Extension ece~vved Application: ~'// eceived Fee:$ ~>-~0 ~:~ Completed Application Incomplete SEQRA Classification: Type I Type Il__Unlisted Coordination:(date sent) LWRP Consistency Assessment Form · CAC Referral Sant: .,,.~Date of Inspection: ~[ Receipt of CAC Report:* - - ' Lead Agency Determination: Technical Review: ,~Pablic Hearing Held: Resolution: NameofApplicant ~es I~Da~[~t~- }~t~0~'t~ ~ Phone Number:( ) 631 '-//It-~ %) ZA Suffolk County Tax Map Number: Property Location: [~,OO ~r~&l IZ~& ; b&~o~-~, (provide LILCO Pole #, distance to cross streets, and location) (If applicable) Address: ~ Phone: ~d of Trustees ApplicatioO GENERAL DATA Land Area (in square feet): [ Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions: If "Yes", please provide copy. Yes >< 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? )0 No__ Yes If yes, provide explanation: Project Description (use attachments if necessary): % J of Trustees ApplicatioO COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Are wetlands present within 100 feet of the proposed activity? No ~ Yes Does the project involve excavation or filling? 5X~) No Yes If Yes, how much material will be excavated? [ (.~ (cubic yards) How much material will be filled? --~ (cubic yards) Manner in which material will be removed or deposited: Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) ~rd of Trustees Applicati~ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: y,o~ ~. [~t~t~,.~ Area of wetlands on lot: <~3 _square feet Percent coverage of lot: (~). C) [ 2 % Closest distance between nearest existing structure and upland edge of wetlands: ~> [Oo ' feet Closest distance between nearest proposed structure and upland edge of wetlands: ~ 'q-O feet Does the project involve excavation or filling? (~ ~ No X 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: 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 attachments if appropriate): I 617.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLIS'I'EI.) ACTIONS Only ( To be ~'npleted by Applicant or Project Sponsor) 2, PROJECT N,~tE 4. PRECISE LOCATION: Street Addess end Road Intersections, Prominent landmarks eic -or DroVi m~_~.m~lo . PART 1 - PROJECT INFORMATION 1. APPLICANT ~ SPONSOR CT LOCATION: SEQR 5. IS PROPOSED ACTION: 6. DESCRIBE PROJECT BRIEFLY: ?. AMOUNT OF LAND AFFECTED: IndJaF~, ~OO (~ acres Ultimately ~, {~ O (~ acres 8. W1LL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? L~Yes I 1 No If no, describe briefly: 9. WHAT iS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) C-j Other (deserve) 10. DOES ACTION INVOLVE A PERMIT APPROVAL. OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) r""~Yes [--"]No If yes. list agency name and permil / approval: 11. DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? ~]Yes [-~No I! yes, list agency name and permit / approval: [ I~SesA ~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 Applicant / Sponsor Nar~ 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 - IMPAGT ~ESSMENT (To be compWted by Lead Agency) r'}Yes ~JNo poten~al for ora~:~, drainage or flooding pi~l)ibms? Ex~ain briefly: C5. ' ;~: s~uent develo~i, or relatad acl~ ~keiy to be Induoed I~ t~e p~ed action? Explain briefly: I ¢7. o I _-- ,, ,,, ,,,,, ,,,,,,,, ,, ,,,,,,,,,, ,,,,, , E. IS THERE, OR IS THERE UKELY TO BE~ CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? frye. ex~ola~t: PART III - DETERMINATION OF SIGNIFICANCE {TO be completed by Agency) INSTRUCTIONS: F~reschadvemee~ectidenW1adab~e~detarmin~whetheritissubstantia~arge~imp~rtantor~em~visesigni~con~ Each effect shoed be assessed in 0onnectiofl with its (a) setting (i.e. mban or ~ral); (b) p~bability Of occurrit',g; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If rmsessmy, add attachnmrfls or reference supporting materials. Ensure that exp!anaflor~ contain sufficient detail to show that all relevant adverse impacts have been ~defltJfied and adsquately addressed. If question d of part a was checked yes, the detasminalion of $ignificanse must evafuata the po~ndai impact of the proposed action on the environmental characteristics of the CEA. Title of Responsible Of~cer Board of Trustees Applicati~ County of Suffolk State of New York BEING DU Y 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 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 REVIEW OF THIS APPLICATION. Signature SWORN TO BEFORE ME THIS DAY OF~x a.~ ,20 14otary Public t. aUltEN M. STANOISH Notary ~ublic, State of New York ~o. 1ST61~ .., (l,ualifi~o~ n SuffoJk County ~mm)ssion Ex, res ~rll 9, APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the hart of town officers and emnlovees. The ouroose of this form is to nrovide information which can alert the town of possible conflicts of interest and allow it to take whatever action iS (Last name, first name, ~nidt~e 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 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. 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 ofthnt person Describe the relationship between yourself (the applicant/agent/rapre sent ative ) and the tom officer or employee. Either cheek 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 (when the applicant is a corporation); B) the legal or beneficial owner of any interest in a non-corporate entity (when the applicant is not a coqmmfion); C) an officer, director, partner, or employee of the applicant; or D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I Signature ..,~aff....~~_ r PrintName 3a~, ! /X 6m..~_ m ,, _ .il dUN 1 7 ~ Soothhold Town Board of Trustees >/ APPROVED BY BOARD OF TRUSTEES TOWN OF $OUTHOLD $outhhold Town Board of Trustees AREA: 12,525 S.F.. (UPLAND PARCEL) 1,500 S.F. (WATERFRONT PARCEL) ELEVATIONS ARE REFERENCED TO N.G.V.D. DATUM GEORGE'S RD. ZONE · -- DENOTES CONCRETE MONUMENT FOUND. LOCA~ONS OF AD~JACENT WELLS AND SANITARY SYSTEMS PER OWNERS AND/OR OCCUPANTS AND ARE NOT CJJARANTEED. SURVEY OF PROPERTY PREPARED FOR MARTHA &r JAMES BAKER SITUATE AT NEW SUFFOLK TOWN OF SOUTHOLD SUFFOLK COUNTY, NEW YORK SCALE I' = 40' JANUARY 17, 200~T S.C.T.M. DI57; I000 SEC. I17 ~ Ol LOT 12 & S.C.T.M. ~ I000 SEC. I17 BLK. 04 LOT 04 FILE NO. 1211 CERTIRED TO: REVISIONS: 01/27,/2003 ~ ~eop. SAN~RY MARTHA BAKER JAMES BAKER STEWART 17TLE INSURANCE COMPANY H.S.B.C. MORTGAGE CORPORATION PAT T. SECCAFICO PROFESSIONAL LAND SURVEYOR, P.C. - SUCCESSOR TO - ~ONALO TASk, LS.