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Home My WebLink AboutTR-7191A 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.: 7191A Date of Receipt of Application: October 19, 2009 Applicant: James Hinsch SCTM#: 126-11-10 Project Location: 7290 Peconic Bay Blvd., Laurel Date of Resolution/Issuance: October 21, 2009 Date of Expiration: October 21, 2011 Reviewed by: Trustee James King Project Description: To replace the existing septic tank and cesspool. 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 October 19, 2009. Conditions: 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. Jam F~.King, Presid~ Board of Trustees 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 Applicatiojp __Wetland Permit Application ,~" Administrative Permit __Amendment/Trans fer/~e~nsion f Received Applicatio~ lO[ ~q¥ ~ ~Received Fee:$ ~ ~-12ompleted Application [O[I q'lO~ __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent)_ __LWRP Consistency Assessment Form CAC Referral Sent: __Date of Inspection: __Receipt of CAC Report: __Lead Agency Determination:__ Technical Review: ~Public Hearing Held: !O!t,.,h_lI. Oq Resolution: Name of Applicant ~'-dcu~ {'4t ,~ Address V, 0 Phone Number: Suffolk County Tax Map Number: 1000- [ Z(~ - tt-I o eropertyLocation: '~,c~o ~eo,~'~ ~ 81~. ~ I '~t tt~r (provide LILCO Pole #, distance to cross streets, and location) AGENT: /C///O/ (If applicable) Address: Phone: of Trustees Applica~n GENERAL DATA Land Area (in square feet): I I~_C ~' Area Zoning: ~%~ ~ '[t~..~i Previous use of property: fr ~ ~ o, Intended use of property: IfC g,, ~ ~ Covenants and Restrictions: If "Yes", please provide copy. Yes 'F No Prior permits/approvals for site improvements: .~ncy . 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): /,c-yet Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthc proposed operations: Iv~0,on' ~'x~'~'5 <Q<f~ 3~-~t~ Area of wetlands on lot: · /~r square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: 4~ qb 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? /~//aV cubic yards How much material will be filled? cubic yards 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: feet Statement of the effect, if any, on the wetlands and tidal waters of the town that ma~result b~y 'i'~as0n of SUC'[i propo~d o-pYa~it;n~ ~uS~ ;t~efi~s {f al~P~-f~3i~t~i ............ PROJECT ID NUMBER PART '1 - PROJECT INFORMATION 617,20 APPENDIX STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) SEQR 1. APPLICANT / SPONSOR 3.PROJECT LOCATION: 4. PRECISE LOCATION: Street Addess and Road Intersection,, 2. PROJECT NAME Prominent landmarks otc-or orovide mao 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: initially acres Ultimately acres 8. WiLL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? LIYes L--~ No If no, describe briefly: 9. WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) [~]Residential []Industrial I~commercial E~Agriculture ~lPark/Forest/OpenSpace I---IOther (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) r~Yes r-"l No If yes, list agency name and permit / approval: ll. UOES ANY A;SP'EL;I (JP IHE ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? i---lYes ]'~No If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE OEST OF MY KNOWLEDGE Applicant / Sp0nsor Namesignature ~ "~'-,¢311,4..,..~ /'"'{'/a,-$'c~ Date: If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT {To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRE~H,OLD IN 6 NYCRR, PART 617.4? if yes, coordinate the review process and use the FULL EAF. B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.87 If No, a negative declaration may be superseded by another inyblved agency. C. COULD ACTION RESULT iN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be hand, written, if legible) C1. Existing air quality, surface or gmundwatar quality or quantity, noise levels, existing traffic pattern, solid waste producflon or disposal, potential for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agricultural, archaeological, historic, or other naturat or cultural resources; or community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A communfly's exisfln~ plans or ~oal$ ~$ offidal~y adopted, or a chon~o in use or intensity of use ot land or other natural rosourco$? fixplain briefly: C5. Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. 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 of energy? Explain briefly: D. WILL THE PROJECT HAVE AN iMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEA/? /!~ yes, explain t~ri~}~! _ _ ] E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? tf),es ex})lain: "° PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidentifiedab~ve~determinewhetheritissubstantia~~~arge~imp~rfant~r~therwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) [rreversibility; (e) geographic scope; and (t~ 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 7e~-, !he dete;m!na~en ef ~!gn!fle.3~ rice must .?.vc!u c t~t he~ete~tiaHm p~ ct cf th c prc~c3cd ~ cftc, ~, .3~, thc c~,v:,~c,n~,,cn~l ch~rGcI~r~ica of [,hA CEA. Check this box if you have identified one or more potan fially large or significant adverse impacts which MAY occur. Then proceed directly to the FULl EAF and/or prepare a positive declaration. Check ~h~s box if yo~l~a-ve dete-rm~n~, based on the information and analysis above and any supporting document~fion~ tha~rop~' WILL NOT resutt in any significant adverse environmental impacts AND provide, on attachments as necessaP/, the reasons supporting thi determination. Name of Lead Agency Date Title of Responsible Officer Pdnt or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency Signature of Preparer (If different from responsible officer) Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) /~p/~r' residing at (print owner o operty) (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 Board of Trustees AppliCon 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, THEm AC~NT(~,LgR REPRESENTATIVES(S), TO ENTER ONTO M~ROPERTY TO 1NSP~CT TI~ PREMISES IN CONJUNCTION WITH REVIF;/W ,~F THIS APPLICATION. ~ '~' Signature SWORN TO BEFORE ME THIS /q~" DAYOF ~)¢t- ,2o et? t~kS(a~ry Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the om of town officers and emalovees. The ourooso of this form is to omvide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is (Last name, first name,~aiddle initial, anless 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 oftbe Town of Southold? "Relationship" includes by blood, marriage, or business interest. "Busipes~ interest" means a business, including a partnership, in which the town officer or employee has even a partial ownemhip 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/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% of the shares of the corporate stock of the applicont (when the applicant is a corporation); B) the legal or 'beneficial own~ of any interest in a non-corporate entity (when the applicant is not a corporation); __C) an officer, director, partnei', or employee oftbe applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS I d'th /*~ da of f~'~ 200 Submitte is/..L~_ y Signature Print Name~ ( ./ DESCRIBED PROPERTY LAUR£L, TOWN OF SOUTHOLD SUFFOLK COUNTY, N,)~ SURVEYED FOR: JOHN C. HINSCH