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Home My WebLink AboutTR-6959A 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 ½ constructed ~'~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.: 6959A Date of Receipt of Application: October 24, 2007 Applicant: Edward Ernst SCTM#: 52-9-1.1 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. James F. King, President Board of Trustees JFK:eac James F. King, President Jill M. Doherty, Vice-President Pegg~ 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 TO: BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Please be advised that your application dated (,..)~'~o~e¢' ¢,3~1/, ~-OO'7 has been reviewed by this Board at the regular meeting of ~£/~ ¢200~>' and your application has been approved pending the con~pletion 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 ($3.00 per sq. ft.) Permit fees are now due. Please make check or money order payable to Town of Southold. The fee is computed below according to the schedule of rates as §et forth in Chapter 275 of the Southold Town Code. The following fee must be paid within 90 days or re-application fees wilt be necessary. You will receive your permit upon completion of the above. COMPUTATION OF PERMIT FEES: TOTAL FEES DUE:$ ,~'O~ BY: James F. King, President Board of Trustees SOUTHOLD 1000 James F. King, President Jill M. Doherty, Vice-President Peg~ A. Dickerson Dave Bergen Bob ~osio, 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 Applics{io~ [ ~WetlandPerrmtApplication ~,~Administrative /~ Amendment/Trans fer/Extensi6n ~/ Rece~vved Application: iO/,9,q [ O'-I j/~Received Fee:$ ,~o~ ~l --,4L~ompleted Application ~ [ __Incomplete __SEQRA Classification: Type I__Type II Unlisted Coordination:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: ~_~.~ate of InspectionL ~ ~ Receipt of CAC Report: ~ ~-' ~ Lead Agency Determination: Technical Review: .2~alSlic Hearing Held: [~ Resolution: Permit NameofApplicant ~,, ]X~'~-~ --~--_._~'~.,~.~._~-i Address L ! ~t-~--~ ~~ ~ Phone Number:( )~[-- ~ Suffolk County Tax Map Smber: 1000- ~ - G - [' ~ (provide LILCO Pole #, distance to cross streets, and location) AGENT: (If applicable) Address: Phone: of Trustees Applicati0 GENERAL DATA Land Area (in square feet): Area Zoning:'~ -~ 0 Previous use ofproperty: '~¢'~_~ I Intended use of property: ~:~2~5 Covenants and Restrictions: If "Yes", please provide copy. __Yes '~No Prior permits/approvals for site improvements: ,x ~/,~ No prior permits/approvals for site improDv ae tem~nts. any permit/approval ever been revoked or su"~ed Has by '4-_._N No a governmental agency? Yes If yes, provide exp~ Project Description (use attachments if necessary):. of Trustees Applieati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: edge square feet ge of lot: % stance between nearest existing structure and upland feet etween nearest proposed structure and upland feet excavation or filling? edge of wetlands Does the project No If yes, how much material will cubic yards How much material will be filled.5 cubic yards Del : deposited: Proposed slope throughout the area of o Manner in which material will be ited: feet Statement of the effect, if a~y, on the wetlands and tidal wa~:ers of the town that may result by reason of such proposed operations (use attachments if appropriate): 617.20 PROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1, APPLICANT / SPONSOR [2. PROJECT NAME 3 PR~JECTT~,~,~LO ATION: Mu nicipa,ity~ ('~T lq, o~b Coun,y bU~ 4 PREOISE ~OOATION: Stre~A~dess and Road In~ersecfio~s, Prominent landmarks e~c -or ~rovid~ ma~ IS PROPOSED ACTION: New ~ Expansion ~ Modification / alteration 6 DESCRIBE PROJECT BRIEFLY: SEQR J7.AMOUNT OF LAND AFFECTED: ,.~'~-,-- , Initially acres Ultimately acres ~. ~-"~¢~'"(~ 8. WIL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? s [] No If no, describe briefly: 9 AT IS PRESENT LAND USE IN VICINI OF PR JECT? (Choose as many as apply ) E~ Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY ((ederal;. State or Local) [~Yes ~ I1 yes, list agency name and permit / approval: '~f: DOES A~ECT OF TRE ACT]ON 1-[A~ZIE A CURRENTLY VALID 15E~I~T OK APPROVAL? E~Yes ~, If yes, list agency name and permit / approval: 12. AS A'~SJ~T OF PROPOSED ACTION WiLL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I C~RTIFY THAT THE INFORMATION PROViD~ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / onsor Na~ ~n~ E~ Date~ ~ 't.,,1 /~ / If the action is a Costal Area, and you are a s~t, agency, L -- complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~enc¥) 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. r'--~ Yes E~]No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR, PART 617.67 If No, a negative declaration may be superseded by another involved agency. []]]Yes ti]No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: {Answers may be handwrffien, if tegible) C1. Existing air qualib/, surface or groundwater qualib/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 wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals as olflcially adopted, or a change in use or intensily of use of land or other natural resources? Explain b[iefly: C5 Growth, subsequent development, or related activities likely to be induced by the proposed action? Explain briefly: C6. Long term, shod term, cumulative, or other effects not identified in C1-C57 Explain briefly: C7. Oiher impacts (!niluding clan?s in use of,,,either qu~nti~y or type of energy? Explain briefly: WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICA E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: I 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 otherwise significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irrevorsibility; (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 d e t e r .ruination o f~kjeif~3Reeq:P~caluat e4he potential impaet ef thc proposed action, oF, thc c ~,v]r o ~ m er t t al~Pcara~tic~o f t h e CF_A. Check this box if you have identified one or more potenflally large or significant adverse impacts which MAY occur Then proceed directly to the FUL EAF and/or prepare a positive declaration. Che~k i~ S b~x ~ yeu ~av~ ;Je{~:rnined, b~sed On the inf~rrnation and analysis ~bove and any ~upporfing document~tJ0n, t~at th~pr0p~s~J a~i~l WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi determination. Name of Lead Agency Date Title of Responsible Officer 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 >ard of Trustees Application County of Suffolk State of New York 3..=-~1'~ [~ ff'~ ~__._L~",) '~'~ \ BEING DULY 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 BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE T( SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE Fl: AND ALL DAMAGES AND CLAIMS ARISING SOI.fi~OLD TOWN T(~N~OF SOUTHC P,/OM AND UNDER OR BY VIRTUE O~ SAIE~ PERMIT(S), IF GRAI APPLICATION, I HEREB'~ AUTHDRIZE THE TRUSTE REPRESENTATIVES(S), 3~O ENTER ONTO MY PROPE PREMISES IN CONJUNCTION ~/ITH REVIEW OF THI \ / SWORN TO BEFORE ME THIS-~q' DAY OF iTED. IN COMPLETING THIS ',S, THEm AGENT(S) OR [TY TO INSPECT THE ,20 o2 ary Public ~,-- kAJ. ap.~ed_in .Surfak County ~mm~ss~on ~xppres April 9, 20.// ard of Trustees Applicat~ A ~U~H. ORIZATION (where the applicant is not the owner) I, ~ residing at . (print ow~ of property) Tm~ address) do hereby authorize ' (Agent) Southold Board of Town j t° a~Pi~hiil.permit(s) fr°m the 8 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the tort of town officers and employees. The ouroose of ~his form is to orovide information which can alert the town of tmssible conflicts of interest and allow it to take whate~er action is necessary to avoid same. (Last name, first.l~ame, gniddle initial unless you are applying in the ame 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 &Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map . Planning Other (If"Other", n~ne the activity.) Do you personally (or through your comp of the Town of Southold? "Relationshi including a partnership, in which the town in which tile town officer or employee owns n , sibling, parent, or child) have a relationship with any officer or employee Iood, marriage, or business interesL "Business interest" means a business, even a partial ownership of (or employment by) a corporation 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/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 own~'r 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 Submitted this..~ ~ dayof Signature ~- , / PrintName/ I I ~ /fgl / Albert J. Krupski, President James King, Vice-President Artie Foster 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 OFSOUTHOLD OTHER POSSIBLE AGENCIES YOU MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Environmental 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. ofHealth Smwices County Center Riverhead, NY 11901 852-2100 U.S. Army Corp. of Engineers New York District 26 Federal Plaza New York, NY 10278 212-264-39t2 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. 518-474-6000 .qI'T'ITATIq. AI~.q/-/A]~I()MAI~T/}~. BOARD OF TRUoT~E~ ~ ~ ............... ~ TOWN OF SC ~ [ ~uw~ OF 50UTHO[D TO'q: SO--OLD [~ ~ / ~ o ~: SUFFOLK COUNT% TAX HAP NUHBER ~ '--' , j ~oo' IOOO - 56 - I - APPLICANT, AN®ELA NORTON EO~ARI~ERNST I1.1 6~O25 MAiN ROAD NORTH SOUTHOLD, NEH YORK MAP PREPARED: 10-2q-02 REC. OI-50-OD, O~-i4-O5, OD-21-OD, O4-OI-OD, O4-OT-OD, REV. BUILD ENV. Orm-lCb-O~, 0-~-0~-05, REV SEPTIC Oq'-2~-O~, ADDITIONAL TESTHOLES IO-OD-O~, BUILDIN~ ~ DEVELOPMENT RI6HTS AREAS 10-28-0D, Il-II-OD, 12-2q-OD, OD-II-04, AMENDED S.C.O.H.S. ~,0# SlO-02-O01q FILE. No. 15370 #ABS. No. I t. IE~Iy CERTIFY ~ T~ ~ A T~ (~ OF M&P I~IOWN A8 ISOUTH FILED AT THE COUNTY CLEhK'80FRCE FILED JAN Z 8 2005 ¢ ¢,, --,~, ,, FILED ' ' 3" 4- ....~. I - JAN 2.8 ]005 ~ OF SUFFOL~ , '""E '221 4:;::' %C¢, \' / / / / , w ¢~-E POND s Korea ag~ ' .' ' r' ~ ,. .... '""' ', c -t91 // PO/vD MAP TYPIGAL PLOT PLAN not to bW SEPTIC SI*SIEM DETAIL HOT TO %ALE ~i~{Ft- ....~ J I L)~ b LOT 4 JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RI~, N.Y. 11901 369-8288 Fax 369-8287 REF-\~P SERVER~%pros~98-114_nys~lane.pro .......... f ~H~r_!' o~ ~