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Home My WebLink AboutTR-6960A James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickorson 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 ½ constructed V//' Project complete, compliance inspection. 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 Permit No.: 6960A Date of Receipt of Application: October 24, 2007 Applicant: Edward Ernst SCTM#: 52-9-1.2 Project Location: Long Creek Drive Ext., Southold Date of Resolution/Issuance: September 17, 2008 Date of Expiration: September 17, 2010 Reviewed by: Board of Trustees Project Description: Hand trim the phragmites to a height no less than 12 inches on an as needed basis. 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 Edward Ernst, and received on October 24, 2007. Special Conditions: The phragmites are to be trimmed by hand only. There is to be no removal or disturbance of any vegetation other than the phragmites on the site that is within the Board of Trustees jurisdiction. 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. JaYmes F~in2sident Board of Trustees JFK:eac James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob Ghosio, Jr. Town Hall 53095Route 25 P.O. Box 1179 Southold, NewYork 11971-0959 Telephone (631) 765-1892 Fax (631) 765-664] BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated OC.-¢'~8¢~. L~,¢?-~7 has been reviewed by this Board at the regular meeting of and your application has been approved pending the com-~tetion 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) __ ½ 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 Southold. The fee is computed below according to the schedule of rates as §et 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: $. ,~ ~ BY: James F. King, President Board of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Bob ~nosio, Jr. Town Hall 53095 Route 25 P.O. Box 1179 Southoid, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only __Coastal Erosion Permit Application. f__Wetland Permit Application )(r Administrative /__AmendmentJTrans fer/Extensiofl-a ]d_P~eceived Application: /t~ Jo~q ] 07 ~/'Received Fee:$ l~-'"~ompleted Application [ 0 __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: ~-dJ~ate of Inspection: Receipt ofCAC Rep$~t:" __Lead Agency Determination: Technical Review: ~Ffi%lic Hearing Held: Resolution: Permit OCT 2 4 2007 8m~lmkl Towl Board ef Tmsb~ Address ~/~l.t-) '~"~4\"'~ _Phone Nu~) Suffolk County Tax Map Number: 1000~-~- Prope~y Location: (provide LILCO Pole ~, distance to cro~reets, ~d location) AGENT: (If applicable) Address: Phone: of Trustees Applicatio0 GENERAL DATA Land Area (in square feet): ~'~ /~Sq Area Zoning: '~-'~ Previous use of property: ~ ~ t~]]2> Intended use of property: ~ , ~) Covenants and Restrictions: If "Yes", please provide copy. Yes ~ No Prior permits/approvals for site improvements: Agency Date Has'an p 'or permits/approvals for site improVers. y permit/approval ever been~oked or su~_e~qboY If yes, provide explanation:/ a governmental agency? Yes Project Description (use attachments if necessary): of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: of wetlands on lot: _square feet e of lot: % ed~ 3tance between nearest existing structure and upland [ands: feet edg, between nearest proposed structure and upland feet Does the )lve excavation or filling? No Yes If yes, how much excavated? cubic yards How much material will be cubic yards Depth of which material deposited: feet Proposed slope throughout f operations: Manner in ~vhich material will or deposited: Statalment of the effect, if any, on the wetlands and tidal waters of the town that may result by reast~ of such PropoSed operations (Use attachments if apPropriate)i PROJECT ID NUMBER PART 1 - PROJECT INFORMATION 1. APPLICANT / SPONSOR 3 PROJE6~"LO~ATION: 6t7,20 APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only ( To be completed by Applicant or Project Sponsor) 2. PROJECT NAME SEQR Municipality "~ ~.-..,(/~-' [ ~"~,. ~ 4 PRECISE LOC~C,Q.~Str-eet A~idess--.eff~oad IS PROPOSED ACTION'~w 6 DESCRIBE PROJECT BRIEFLY: Intersections, Prominent landmarks etc -or provide map E~ Expansion [] Modification / alteration 7 AMOUNT OF LAND AFFECTED: ~-~'~ S Initially acres Ultimately acres WILL ROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~ [] No If no, describe bdel]y: 9 WH IS PRESENT LAND USE IN VICINIT~ OF P JECT? (Choose as many as apply.) ~dential []Industrial ~Commercial ~culture []Park/Forest/OpenSpace E~ Other (describe) 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCYe6~ral.~,'Sederal tare or Local) E~]Yes L~O If yes, agency name and permit / approval: list \ 11 UL~bS~A A~.~cr O~- ]NE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E]Yes ~No If yes, list agency name and permit / approval: 12~ AS'A~'F~ESLI,L-~ Q~ PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MOD FICATION? E~Yes ~oI/ ' I CETI~/~f' THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEI~GE ~/~ ~ t~tion is a Costal Area, and you are a s~te agency, // ~mplete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lenc¥) 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. E~TM E~No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNL STED ACT ONS IN 6 NYCRR, PART 61767 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 handwritten, if legible) C1 Existing air quality, sur[ace 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 community or neighborhood character? Explain briefly: C3. Vegetation or fauna, fish, shellfish or wtidtife species, significant habitats, or threatened or endangered specie~?"Explain brieflyi ' C4. A community's existing plans or goals as officially adopted, or a change in use or intensity of use of land or other natural resources? Explain briefly: C5 Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long ~erm, shor~ term, cumulative, or other effects not identified in C1-C57 Explain briefly: 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 E ~S THERE, OR PS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? if },es explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: For each adverse effect identified above, determine whether it is substantial, Iarge, important or otherwise significant. Each effect should be assessed in connection with its (e) setting (i,e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (f) magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that ali relevant adverse impacts have been identified and adequately addressed. Ii' question d of part ii was checked yes, the4Jetermination of signif'm,,a,qce must eveluate-thepo~tiaH mpcct of thc prc, poocd action of~ the environme~aFcharacteristic:sof~[ha Check this box if you have id entitled one or more potentially la rge or significa nt adverse im pacts which MAY occur Then proceed directly to the FULL EAF and/or prepare a positive declaration. Check this box it yoLJ ~V~ de~rn~n~d, b~sed on (he i~fermation and analysis above and any suppoding documentation, th~l the prop0s~d ~ctia~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppodin9 thi.~ determination. Name of Lead Agency Date Title of Responsible O~cer Signature of Preparer (If different from responsible officer) Print or Type Name of Responsible Officer in Lead Agency Signature of Responsible Officer in Lead Agency of Trustees Applica oti~ County of Suffolk State of New York ['--'~[-.J/~%~[ ~ ~---T~,jO } [ BEING DULY SWORN DEPOSES AND AFFII~IS THAT HETSHE 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 UNDER OR BY VIRTUE OF S.al/lB APPLICATION, I HEREBY AU/I'H REPRESENTATIVES(S), TO Elq'[l PREMISES IN CONJUNCTIO~ SWORN TO BEFORE ME THIS AND ALL DAMAGES AND CLAIMS ARISING :RMIT(S), IF IZE THE TR1 ONTO MY PI H REVIEW O! ~I~ETED. IN COMPLETING THIS S, THEm AGEN_~T~) OR OPERTY TO IN~CT TIlE tture DAY OF (~e OB'~h _,20~ ~'NDtary Public LAUR£N M. STANDISH ,, .N.o. 0,1ST6164008 _ uualifiod_ n Suffolk Courdv uommssion ExplresAprfl9, 2-0 // Oard of Trustees Applicat~ AUTHORIZATION (where the applicant is not the owner) (print of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town :ees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics orohibits conflicts of interest on the hart of town officers and emolovees. The Duroose of this form is to r)rovide information which can alert the town of possible conflicts oflntem~t and allow it to take whatever action is necessary to avoid same. (Last name,'fimt na/ne, raidcl~ initial, unless~'~u 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"Otber'~, name the activity.) Do you personally or through your company, s~use, sibling, parent, or child) have a relationship with any o!,ficer or employee oftheTownofSouthold? "Relationship" includ~by blood, marriage, orbusinessinterest~"Businessinterest means a business, including a partnership, in which the town officer o~mployee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more tha~f 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/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 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); __.C) an officer, director, partner, or employee of the applicant; or __.D) the actual applicant. DESCRIPTION OF RELATIONSHIP Form TS 1 Albert J. Krupski, President James King, Vice-President Artie Fester Ken Poliwoda Peggy A. Dickerson Town Hall 53095 Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-1366 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD OTHER POSSIBLE AGENCIES YOU'MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Enviromnental Conservation (DEC) SUNY, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of Health Services County Center Riverhead, NY 11901 852-2100 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 212-264-3912 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. Albany, NY_ 12232 518-474-6000 "NIII.L, t:ff. h;~[~ I-'KIC~I{.V~f' APPROVED S~A~.' ~S~- -O~~o~ , . K TOWN OF SOUTHOLD TO~. SO,HOLD S~OLK CO~Y, N.Y. SUFFOLK GOUN~ TAX HAP NUHDE~ I I000 - 56 - I - II.I APPLICANT: ANCELA NORTON EDlNAIa42 Et~.NST 61025 MAIN ROAD 50UTHOLD, NEi,'4 'fOR. K MAP PREPARE/~: 10-2q-02 REV. OI-DO-OD, OD-14-OD, OD-21-OD, 04-OI-OD, 04-07-05, ~V. ~UILD ENV. 06-16-0~, O~-OD-OD, ~5V SEPTIC 07-2D-OD, ADDITIONAL TESTHOLE5 IO~-OD, IO-Oq-O~, DUILDIN~ ~ ~5~LO~ENT ~I~HT5 A~A5 ~0-26-0~, If-il-05, 12-2q-OD, OD-II-04, AHENDED 04-0~-04 ~.C,.O.H.5. W,O~* 510-02-001<:;I SOUTH ~,.,, I ~A~T NOI~TH I I. EREBy CERIFY 1HI8 TO BE A TRUE IZ)PY OF MAP KNOWN A8 11216 # FILE No. 15370 #ABS. No, FILED JAN Z 8 2005 ~ 09= FILED AT '~-IE COUNTY CL E'FIK'80FF1CE CLERK OF 8UFFOtK COUNTY FILED '-- ~," C4.ERK OF SUFFOLK COUN~f , -"5 2.21.~5' POND W~Es NOTE~3: ¢ mC' LOT b (LOT COVBRA¢5 TADLE 07 privO MAP TYPICAL PLOT PLAN no~ t.o J 1-¸ :l I (J f 2 LL) T 4 JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N,Y,S. LIC, NO. 50202 RIVERHEAD, N.Y. 11901 REF-\'ffIPSERVERYF\pros\98-114_nys~lane.pm 369-8288 Fax 369-8287 1 SHEET__!. O_F~2