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HomeMy WebLinkAboutTR-6962A 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 H~l 53095Route 25 P.O. Box 1179 Southold, New York 11971-0959 Telephone(631) 765-1892 Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OFSOUTHOLD Permit No.: 6962A Date of Receipt of Application: October 24, 2007 Applicant: Edward Ernst SCTM#: 56-1-11.14 Project Location: Long Creek Drive, 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 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 been reviewed by this Board at the regular meeting of ! 2/¢2¢~ and your application has been approved pending the cor~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) 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: $ ~"~ o~ BY: James F. King, President Board of Trustees James F. King, President Jill M. Doherty, Vice-President Peggy A. Dickerson Dave Bergen Town Hall 53095 Route25 P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: Name of Applicant: Name of Agent: Property Location: SCTM# & Street Brief Description of proposed action: T.}rpe of area to be impacted: '~/Saltwater Wetland ~Freshwater Wetland Distance of proposed work to edge of above: Sound Front Bay Front Part of Town Code proposed work falls under: ~hapt.~r7 Chapt. 37 other Type of Application: __ Wetland __Coastal Erosion __Amendment ~dministrative __Emergency Info needed: Modifications: Conditions: Present Were: __J.King J.Doherty __P.Dickerson __ Other: D. Bergen ¢ok 6-~s,o Maiied/Faxed to: Date: Comments of Environmental Technician: ~ ~ .'1 ~ , I%1 056 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. ZWetland Permit Application ~Adminis~ative Permit ~R __AmendmenffTrans fer/Ext~nsion eceived ApplicationL ~eceived Fee:$ .5-0°.) D~'Completed Application __Incomplete SEQRA Classification: Type I~Type II Unlisted Coordination:(date sent) LWRP Consistency Assessment Form CAC Referral Sent: ,~ate of Inspection: Receipt of CAC Report: Lead Agency Determination: Technical Review: ~fi~blic Hearing Held: I~ Resolution: CEgVE OCT 2 4 2007 SeuthheM Town __ Board ef Trustm~ Name of Applicant Suffolk County Tax Map Number: Property Location: (provide LILCO Pole #, distance to cross streets, and location) AGENT: / (If applicable) Address: Phone: of Trustees Applicati~ GENERAL DATA Land^rea ins, nare,:eet : Previous use of property: ~ ~ Intended use of prope~y: ~ ~ Yes ~No Covenants and Restrictions: If "Yes", please provide copy. Plior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or'~pen~,~d by -s No If yes, provide explanation: a governmental agency? Yes Project Description (use attachments if necessary): Ck.)'"~- of Trustees Applicati WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose ofthe proposed operations: ~"'~-~'- ,}- Or~.~[~x_~,'~.~.,,~_ of ~vetlands on lot: Perc : coverage of lot: ed Closest distan, edge of wetlands feet Does the proy or filling? No Yes If yes, how much materia be excavated? How much material will ? Depth of which material will be Proposed slope throughout the Manner in which material will be rem _square feet % earest existing structure and upland feet 3etween nearest proposed structure and upland cubic yards cubic yards 3ved or deposited: >erations: or deposited: feet Statement of the effect, if any, on the wetlands and tidal ~vaters of the town that may r_esult 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 ~v ~ County 4 PRECISE Oq~..~,~lON: Street Addess and Road Intersections, Prominent I"a~Fdmarks etc - or nrovide mad SEQR 5. IS PROPOSED ACTION: ~New [] Expansion [~ Modification / alteration 6. DESCRIBE PROJECT BRIEFLY: In. itially acres Ultimately acres 8. WILL REPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [] No If no, describe briefly: \ ~HAT IS PRESENT LAND USE IN VICINITY (~[F PF~OJECT? (Choose as many as apply.) i L~ Res,dential [] industrial E~commercial L~griculturo E~ Park / Forest / Open Space E~] Other (describe) 10.' DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal,/State or Local) E~Yes [----~Lf~ If yes, list agency name and permit / approval: ), ~'f. DOES AN~',N'f'~9~F'P'b(;I (JP IHE ACFION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? E]Yes ~ If yes, list agency name and permit / approval: 12, AS A~t~SULT OF ¥ CERTIFY PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY K~OWLEDGE '~on ~ L ~ ~ ~ ~ ' ~a~tal~a, y areastateagency, ~et~he~astal ~s~.t Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE ~ THRESHOLD IN 6 NYCRR, PART 617.4? Jf yes, coordinate the review process and use the FULL FAF. r-]Yes r--~ 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· E~] Yes r--~ No c. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING: (Answers may 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 wildlife species, significant habitats, or threatened or endangered species? Explain briefly: ~ y' ' i g pla s or goals as officially adopted, or a change in use or intensity o use o and or other natural resources? ExCain briefly: C5. Growth, subsequent development, or related activities likely ~o be induced by the proposed action? Explain briefly: C6. Long term, short term, cumulagve, 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 ENV RONMENTAL AREA (CEAt? tit ~'est exjolain briefl. ~,.' E. IS THERE, OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If yes explain: PART III - DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTIONS: F~r eachadversee~ectidenti~edab~ve~determine~hetheritissubstantia~~~arge~imp~rtant~r~therwisesignificant~ Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration; (d) irreversibility; (e) geographic scope; and (0 magnitude. If necessary, add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been id entitled and adequately addressed. If question d of par[ ii was checked yes.the determ!~t!cr'¢of $i§ni~¥-.e ~cs must cvcluate-thepetentia~impaet oRheprcpose6aetioF, cn thc cnvlrcnm~at&l ch~racter~at[c~ ofthe6EA. 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 and/or prepare a positive declaration. Check this b~x i~yo~l~ de~min~d, b~sed on the information and analysts above and any supporting document~tionl that ~h~ propes~d actio~ WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting this 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 Applicat£on County of Suffolk State of New York GD~'"J/~ }'~ ~'~ ~-'"[?KJ'4'~ 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 SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN TRUSTEES HARMLESS AND FREE FROM AN' JD ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID J~ APPLICATION, I HEREBY AUTI~)i REPRESENTATIVES(S), TO EN]]~EI~ qTO MY PROPF~RTY TO INSPECT THE PREMISES IN CONJUNCTION ~(/IT ~EVIEW OF THIF4 APPLICATION SWORN TO BEFORE ME THiS lIT(S), IF GRANTED. IN COMPLETING THIS THE TRUSTEES, THEIR AGENT(S) OR DAY OF ~2:1~0¢4 _,20D7L Public LAUREN M. ~I'ANDISH Notary Publlo, State of New York No. 011516154008 Qualified in Suffol}~ ~unt~ Commission Expires April 9,20 ~// of T~stees ~p~cat~ e A~O~ZA~ON the applicant is not the owner) I, residing at (print owner o~operty) (mailing address)  do hereby authorize '  (Agent) apply for pe~it(s) from the Southold Board of Town Trustees on,all. (Owner's sign APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE. FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the oart of town officers and emnlovees. The ouroose of this form is to erovide information which can alert the town of oossible conflicts of interest and allow it to take whatever action is necessary to avoid same. (Lasrlfame, ~irst name, ~aiddle initial, unless 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.) Trax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other Of"Other", name the activity.) Do you personally (or through your compm~y, spouse, sibling, parent, or child) have a relationship with any officer or employee of the Town of Southold? "Relationship" includ~by blood, marriage, or business interest. "Business interest" means a business, including a partnership, in which the town officer bxr employee has even a partial ownership of(or employment by) a corporation in which the town officer or employee owns more t~ of the shares. YES NO f ~ 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 llne 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 thc shares of the corporate stock of the applic0nt (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 Signa_~_~ Print 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. ofHealth Sciwices 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 12231 518-474-6000 TO.q: SO--OLD .... ) S~OLK CO~, N.Y. ~~v ~ro~e ~e~ ~o~ ,'"'----" ANOELAED~ NORTONE~NST //~ ~~0CT 2 4 2007 7/ °44&b" REV. OI-.O-05,05-'4-O',O'-2[-O'.04-O'-O',04-O'-O', .,,~ ~ ~V. BUILD ENV. O~-I~-O~, O~-O~-O~, ~EV 5EPTIG OJ-2~-O~, , A~DITIONAL ~STHOLE5 iO-O~-O~, IO-Oq-O~, 5.G.D,H.5. ~,O~* 510-O2-OOIq 11216 #FILE. No. Z 5 } 7 0 # ABS. No. I Hi~y OER]I¢/THIS TO I~ A ~UE ~ FILED AT TIlE COl. gl'rY CLE-F[K'S OFFIOG CLERK OF 8UFF(X.K COUNTY FILED JAN Z 8 2005 FILED ,/ JAN ZB ZOO5 EDWARD P. ROMAINE BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE 6£? /¢' a,5' ORAPHIG 5GAL-E I"=1OO' p, or~d T'CPI©AL PLOT PLAN 5EPTIG S'FS I Eh4 DETAIL 3R !i 10-r 5 PATE:_ BY: PA~¢. :'"* ? II)] 2 6 EAST MAIN STRRF. T ~, N.Y. 11901 369-8288 Fax 369-8287 JOHN C. EHLERS LAND SURVEYOR N.Y.S. LIC. NO. 50202 REF-\'tH~ SERVERW~pmsX98-114_nys_plane.pro I?HEET 1 OF 2