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HomeMy WebLinkAboutTR-7233AJill 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 Permit No.: 7233A Date of Receipt of Application: January 19, 2010 Applicant: William & Joan Stiles SCTM#: 116-6-14 Project Location: 12700 New Suffolk Avenue, Cutchogue Date of Resolution/Issuance: February 24, 2010 Date of Expiration: February 24, 2012 Reviewed by: Board of Trustees Project Description: To install an additional overflow 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 in the application and on the site plan stamped approved on February 24, 2010. Special Conditions: None. 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. Jill M. Doherty, President Board of Trustees JMD:eac Jill M. Doher[y, President James F. King, Vice-President Dave Bergen Bob Ghosio, JL John Bredemeyer P.O. Box I 179 Southold. NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: PECONIC CESSPOOL ON BEHALF OF WILLIAM & JOAN STILES REQUESTS A JURISDICTIONAL DETERMINATION TO INSTALL AN ADDITIONAL OVERFLOW CESSPOOL. LOCATED:I2700 NEW SUFFOLK AVE., CUTCHOGUE. SCTM#116-6-14 Type/of area to be impacted: i=,fir~ltwater Wetland Freshwater Wetland Sound i/-~ay Distance of proposed work to edge of wetland Part, pfq'own Code proposed work falls under: ~,z~hapt.275 Chapt. 111 other Type of Application: ~/~etland __Coastal Erosion ~Amendment __Administrative__Emergency Pre-Submission __Violation info needed: Conditions: PresentWere:~/~.King ~.Do~h~e~y ~J~.'Bredemeyer ~D. B.Ghosio, __ D. Dzenkowskiz,,,~ other Form filled out in the field by Bergen__ Mailed/Faxed to: Date: ELIZABETH _4. NEVILLE, RMC, CMC TOWN CLERK REGISTRAR OF VITAL STATISTICS MARRIAGE OFFICER RECORDS MANAGEMENT OFFICER FREEDOM OF INFORMATION OFFICER Town Hall, 53095 Main Road P.O. Box 1179 Southold, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.northfork.net OFFICE OF THE TOWN CLERK TOWN OF SOUTHOLD TO: FROM: DATED: January 12, 2010 Transmitted herewith is a copy of application No. __ Permit submitted by: Southold Town Building Department Carol Hydell, Southold Town Clerk's Office 3926 for a Cesspool/Septic Tank ALTERATION Peconic Cesspool for WilHam & Joan Stiles Please review the application and location map and advise if the project has received Suffolk County Health Department approval and if this office may issue the permit. Please complete the form below and return it to me. Thank you Carol Hydcll I have reviewed the application and location map of the project cited above and make the following recommendations: APPROVE DISAPPROVE Comments: Maintain required setbacks fi:om adjacent wells, buildings, property lines and water Bodies. EXCAVATION INSPECTION REQUIRED. Signature Dated RF~ISTRAR OF VITAL STATISTICS MARP/AGE OFFICER REOORD~ MANAGEMENT OFFICER FREEDOM OF ~'~FOP/~IATION OFFICER Town Hall, ~3095 Main Road P.O. Box 1179 Southeld, New York 11971 Fax (631) 765-6145 Telephone (631) 765-1800 southoldtown.nor th fork.net OFFICE OF 'i'H ~: TOWN CLERK TOWN OF SOUTHOLD SOUTHOLD WASTEWATER DISTRICT APPLICATION CONSTRUCTION or ALTERATION PERMIT CESSPOOL or SEPTIC TANK Residential ~ $10 __ or Non-Residential ~ $25 __ Application No. Permit Applicaut Name PECONIC CESSPOOL Applicant MailingAddress P.o. BOX _..487 LAUREL, NEW YORK 11948 S~ptic Tank ~ or Cesspool ~( ....... Brief Dcscrigti~ {~f Propos~ Constr~ctiorl~ Alteration Location of Proposed Consg~qtioin/Alteration: ! OwnerofProperty: N/-~f---~P~'/~ / Owner Mailing Address: · APPROVED ~7 ')ARD 01: TRUS]T ~ · '.VN OF SOUTH,.";'- .9-~H-/o o~eA' ' SOUTHOLD Jill M. Doheny, President James F. King, Vice-President Dave Bergen Bob Ghosio, Jr. John Bredemeyer Town Hall, 53095 Main Rd. P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only ~Coastal Erosion Permit Application __Wetland Permit Application ~/"Administrative Permit Amendmenffrrans fer/Extension ~--"Receiv~d Application:, I~ [~ [ tO ~/Received Fee:$ ~-O " ' ~ompleted Application I ! __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: ~_Agate of Inspection: ~.~._\ I'~[ I~ __Receipt of CAC Report: __Lead Agency Determination: Technical Review: ~_-,l%blic Hearing Held: ~--\~',~[ ID __Resolution: NameofApplicant ~X~d~0,~lg~ i 7~CL~[ -~¢/'~ Address d 7C C ~f~J~ -~~ ff~ ~ ~~f~ PhoneNumb~:( ) ~[ ~ Suffolk County Tax Map Number: 1000- //~ -- ~- /~ Prop~y Location: / ~7~ :qffP~( ~9~ ~ ~ (provide LILCO Pole ~, dist~ce W ~oss s~eets, ~d lo~fion) (If applioable) Address: Phone: Board of Trustees Applicati~ GENERAL DATA Land Area (in square feet): / & /Ti t-~'~'~ Area Zoning: ~tg~C~~~ Previous use ofproperty:. '~/C 3~ ~ Intended use of property:. 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 suspqnd/ed by a governmental agency? k-/No Yes If yes, provide explanation: Project Description (use attachments if necessary): PROJECT ID NUMBER PART1-PROJECTINFORMATION 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 12 PROJECT NAME Municipali~ '~_~ ~ ~~/ J Coun~ ~ ~1~ 4. PRECISE LOCATION S~e~t Addess and Road I~ erosions, Prominent andma~s e~-or ~rovide ma~ 5. ~s P~OPOSED ACTION: ~ Nsw ~ ~pa~s~o~ ~ U~on~ 6. DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially acres Ultimately acres 8. WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~Yes [] No If no, describe briefly: RAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as appry.) esidential E~lndustrial [~Commercial r~Agriculture g~Park/Forest/OpenSpace ~]Other (describe) 10: DOES ACTION INVOLVE A PERM,T APPROVAL, OR FUNDING, NOW OR ULTIMATELY PROM ANY OTHER GOVERNMENTAL AGE Y (Federal, State or Local) ~Yes ~lNo If yes, list agency name and permit / approval: ll. UL)I:S ANY~IY A~A'PECT OF THE AGIION H~VE A CURRENTLY VALID PERMIT OR APPROVAL? I~Yes ~/No If yes, list agency name and permit / approval: 12. AS AR~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' Name [ / ~ . 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 THRESHOLD IN 6 NYCRR, PART 817.4? If yes, coordinate the review process and use the FULL FAF, r-~ Yes [~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.6? If No, a negative declaration may be superseded by another involved agency. C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may be handwdtten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic pattern, solid waste production or disposal, potenhel for erosion, drainage or flooding problems? Explain briefly: C2. Aesthetic, agdcult~l~ a~d~aeological, htstedc, or other natural or cultural resources; or community or neighbod~ood character? Exp a~n bne y C3. [~-~tati(~-~'i ~a, fish, shelitish or Wildlife spe(~i~s, signiflcant habitats, or threatened er endangemd specie~? E×"laln~l~fiefl~i ....... C4. A eommuni~'$ ~×istin§ plans or ~oals as officially ado~t~l, or a Chenge in u~ ~ inten$i~/of u~ o~ land or other natural re$ou~$? ~xplain bfiefi~ C5, Growth, ~,,h~q~nt ~veiopment, ~ rotsted acti¢itiaa Iihety to pe nduced blt the propo~d action? Ex~lain briefllt: ....... led CS. Long term, shod tenn, comulative, or other effects not ident e in C~4~57 ~L~ptsin beefllt: , .... C7. Other impact~ lin~udin~ chart[les in uae of either ~uanfi~ ort~ of ene~l~'. Explain beefier: D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA ICEAI? Ill )'es, explain briefly: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: I-][71NoI PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, large, important or othem/ise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) ir~eversibility; (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, the determination of significa nco must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA. Check this box ~f you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULt EAF and/or prepare a positive declaration. Check this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed actior WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thk determination. Board of Trustees Name of Lead Agency Jill M. Doherty Pdnt or Typ/e/Name of Responsi~ O~er i_n~Agency Si:re of Res'ponsible Offfcer in Lead~ency President Title of Responsible Officer Signature of Preparer (If different from responsible officer) Board of Trustees AppliCon County of Suffolk State of New York dOff~J_A /~. ~9 BEINGDULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR ~ 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), I~ 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-~c~-,,._,.o.,-,N ,20 X,~ Notary Public ADCIA WALKER ~.-~y Public, State of New York No. 01WA6153064 Qualified in Suffolk County Commis.~ Expb'es Sept Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, ~{~ ~t~ '~~ residing (prir~t owner of property) (mailing addre~) ~ ~ do hereby authorize / ~~ ~//~ ~ / (Agent) ~ _~C to apply for pe~it(s) from the Southold Board of Town Trustees on ~ behalf. (owner s si~na(~r~) 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE, FORM The Town of Southold's Code of Ethics urohibits conflicts of interest on the oart of toWn Officers and emulovees. The unrunse of this form is to nmvide i~fformation which can ale~t the town of t~ossible conflicts of intereSt and allow it to take whatever action is uece r¥ to avoid sam , I}i(/ ,/ lc/ (Last name, first name,~iddle initial, unless you arc ap.ply?g in the name of someone else or other $utity, such as a company. If so, md~cat~ thc 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 offcial 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 Southoid? "Relationship" includes by blood, marriage, or bUSiness interest. "Busine~ 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 applicant/agenl/reprcsentative) 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 ~hild is (check all that apply): A) the oy~ner 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 corporation); __~2) an officer, director, paflner, or employee oftbe applicant; or __D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 ~ 700 APPROVED BY ")ARD 01: TRUST~ ';VN OF $OUTH©L~! otJe~'