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Home My WebLink AboutTR-6961A 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.: 6961A Date of Receipt of Application: October 24, 2007 Applicant: Edward Ernst SCTM#: 52-9-1.3 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. Jam~es F. c~' 'r~e~s ident King, Board of Trustees JFK: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 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 0¢J¢0~¢~'-~,~/~00~ has been reviewed by this Board at the regular meeting of ~/::::¢~4~ I ~ ~td, o<, and your application has been approved pending the completion 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) 1/~ Constructed ($50.00) v//' 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 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 Application __Wetland Permit Application ~dministrative Permit AmendmentJTrans fer/Extens~on ~eived Application: [ ~__..Gomplete d Application __Incomplete __SEQRA Classification: Type I Type II Unlisted __Coordination:(date sent) __LWRP Consistency Assessment Form CAC Referral Sent: ~l~rte of Inspection: ~ Receipt of CAC Report: __Lead Agency Determination: Technical Revie~v: ~---"Public Hearing Held: I ~{-~[0_~ ql(llot __Resolution: OCT 2 4 2007 Seuthhehl Town Boa~ of Trustees Name o f Applicant __~gD/~ ~-~> ,,daress Phone Number:( Suffolk County Tax Map Number: 1000-~--~- Prope~yLocation: ~ ~/C ~ (provide LI~CO Pole ~, distance to cross AGENT: (lf applicable) Addrcss: Phone: of Trustees Applicati~ 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 ~/}~vements: ~No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or~en~.~d by a governmental agency? If yes, provide explanation: / ~2:~No Yes Project Description (use attachments if necessary): of Trustees ApplicatJ WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area ofwetl~ds on lot: square feet Percent covera~ of lot: % Closest distance bxetween nearest existing structure and upland edge of wetlands: ~ feet Closest distance betx~een nearest proposed structure and upland edge of wetlands: ~ _feet Does the project involv~xcavation or filling? No]~ Yes If yes, how much.m/aterial x~l b~ excavated?__cubic yards How much mat.. erial will be fi~ed ?~cubic yards Depth of which mat. erial ;viii b~emoved or deposited: Proposed slo~ughyut the ar~ of operations: Maimer in which material will be r~irnoved or deposited: feet 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 htta~hments it' ~ppropriat~si 617.20 pROJECT ID NUMBER APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART I - PROJECT INFORMATION ( To be completed by Applicant or Project Sponsor) 1 APPLICANT/SPONSOR 2. PROJECT NAME 4 PRECISE LOCATION: Street Addess an~oad Intersections. Prominen~ landmarks etc -or provide map SEQR 5 IS PROPOSED ACTION: ~New [] Expansion [] Modification / alteration DESCRIBE PROJECT BRIEFLY: Initially acres Ultimately acres [~ ~ ~ ACTION COMPLY W~TH EXISTING ZONING OR OTHER RESTRIC · WILL OPOSED es [] No If no, describe briefly: PRESENT LAND USE IN VICINITY F PROJECT? (Choose as many as apply ) E~]lndustdal [~]Commer nculture ~] Park / Forest / Open Space ~] Other (describe) 10 DOES AGENCY E~] Yes INVOLVE A PERMIT APPROVAL, OR FUNDING, State or Local) If yes, list agency name and permit / approval: NOW OR ULTIMATELY FROM ANY OTNER GOVERNMENTAL [~Yes VALID PERMIT OR APPROVAE? If yes, list agency name and permit / approval: 12. AS A Applicant / PROPOSED ACTION WiLL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OFMY KNOWLE1 ~.~E~,~.~;~ iE pl~ Costal Area, and you are a state agency, c ete 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 6t7.47 If yes, coordinate the review process and use the FULL EAF. ["-]Yes r-"l No 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, IZ] Yes FqNo C~ COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOW NG (Answers n ay be handwritten, if legible) C1. Existing air quality, surface 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 witdlifo species, significant habitats, or threatened or endangered species? Explain bdefiy: C4. C5 A community's existing plans or goals as officially adopted, or a change ~n use or intensity of use of land or ether natural resources') Explaln briefly Growth, subsequent ~veiopmen, '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 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 (CEAI? (If yest ex~u!a!~ t~defl¥: E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? ?'yes exp!a!n PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~reachadversee~ectidenti~edab~Ve~determineWhetheritissubstantia~~~arge~imp~rtant~r~~herwisesigni~cant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probabilih/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 all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,, t hedetermination of sign it ica nco mu st evaluate the pote n tial impact of the proposedac~iorrorr the envirorrrrrentat characteristicso~ the C UA, Check this box if you have identified one or more potentially large or significant adverse impacts which MAY occur. Then proceed directly to the FULL EAF arid/or prepare a positive declaration. Check this boxif you have determined, based on the information and analysis above and any supporting documentationl that~h~ proposed action WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons suppoding 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 of Trustees Application County of Suffolk State of New York DEPOSES AND AFFIRMS THAT HE/SHE 1S 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 IF GRANTED. 1N COMPLETING THIS SAII~ERMIT(S), APPLICATION, I HEREBY AUT~tOIyZE THE TRUSTEES REPRESENTATIVES(S), TO EN[ER DNTO MY PROPER"[ PREMISES IN CONJUNCTION ' t¢ITIJ REVIEWOF THiS Signature SWORN TO BEFORE ME THIS (4~q/~- 'THEIR AGENT(S) OR Y TO INSPECT THE DAY OF_~(O~ LAUREN M STANDISH No. O.~STS)I~40 ~ O.ual fled In Suffolk ~unb, uomm ss~on Expires April g, 20../.L of Trustees Applicat. AUTHORIZATION (where the applicant is not the owner) (print ir of property) residing at (mailing address) do hereby authorize (Agent) to apply for permit(s) from the Southold Board of Town tees on my behalf. (Owner's signature) APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics vrohibits conflicts of interest on the oast of town officers and emvlovees. The oumose of this form is to orovide information which can alert the town of ~oasible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Last name, Erst name,)l~iddle initial, unless you a~ 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 aay officer or employee oftbe 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 co.ration in which the town officer or employee owns more than 5% oftbe shares. YES NO If you answered ~'YES", complete tile balance of this form and date and sign where indicated. Name of person mnployed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicanffagenl/representative) and the town officer or employee. Either cbeck 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 (wben 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 I 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 OF SOUTHOLD OTHER POSSIBLE AGENCIES YOU' MIGHT HAVE TO APPLY TO N.Y.S. Dept. of Enviromnental Conservation (DEC) SUNW, Bldg. 40 Stony Brook, NY 11790-2356 (631) 444-0355 Mon., Wed., Fri., 8:00 AM-3:00 PM Suffolk County Dept. of I lealth Services County Center Riverhead, NY 11901 85242100 U.S. Army Corp. of Engineers New York District 26 Fedcral Plaza New York, NY 10278 212-264-3912 N.Y.S. Dept. of State Coastal Management 162 Washington Ave. Albm~y, NY 12231 518-474-6000 SITUATE: ARSHAMOMAQUE TOWN: SOUTHOLD SUFFOLK COUNTY, N.Y. GUt:FOLK COUNT'f TAX MAP NDMBEP-- IOOO - 5(::, - I - I1.1 APPLICAN% AN~ELA NO~TON ED~AR~ ERNST MAIN ROAD DOUTHOLD, NE!N YORK MAP PREPARED, 10-2q-02 REV. OI-DO-OD, OD-14-O~,, OD+21-O;~, O4-O[-O3, O4-O1-O3, P-.EV. BUILD ENM. O&-I~-OD, OT-OD-OD, REV DEPTIC ADDITIONAL TEDTHOLED IO~OD-O~, IO-Oq-OD, BUILDINg-, ~ DEVELOPMENT ~I~HTD AREAS 10-2D-O~, Il-II-OD, 12-2q-OD, ODdl-04, AMENDED' APPROVED BY BOARD OF TRUSTFES TOWN OF SOUTHOLD ~TAN'r PITC NOt~,TN &oUTH i h~y CERT~ 1HI8 TO lie A TRUE (~ OF MAP KNOWN A~ FILED AT ~'IE COUNTY CJ. ERK'80FFIC~ 6UFFOLK COU~NT'~ ON -( 07: I 11216 #FILE No ~ ~ ~ ' '" ~OF~~ *~*"~" TTPIOAL PLOT PLAN 15 7 7 0 ~ ADS. N0. ,o, ,o ** FILED JAN 2 8 20B5 . .. --,., ,, ~. ~*T**. ~ KZY HAl=, DL i"¸ LOT 4 6EASTMAINS'II~ET R1VERItEAD, N.Y. I1901 369-8288 Fax369-8287 JOHN C. EHLERS LAND SURVEYOR N.Y.S. LIC. NO. 50202 REF-\'fflPSERVER'~pros\98-114_nys~lane.pro _[SHEEI', 1 OF 2