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HomeMy WebLinkAboutTR-7748A James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 CERTIFICATE OF COMPLIANCE # 0742C Date: April 17, 2012 THIS CERTIFIES that the installation of a new leaching pool landward of the existing At 905 Fleetwood Road, Cutchogue, New York Suffolk County Tax Map # 137-4-23 Conforms to the application for a Trustees Permit heretofore filed in this office Dated March 19, 2012 pursuant to which Trustees Administrative Permit #7748A Dated March 21, 2012 was issued and conforms to all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of a new leaching pool landward of the existing The certificate is issued to ROBERT LEHNERT owner of the aforesaid property. Authorized Signature APPROVED BY BOARD OF TRUSTEES TOWN OF SOUTI'K)m WETLAND FLAGS AS SET BY R FOX OF SEALEVEL MAPPING S salt marSh 23.50,, F~ E E K ,,% average high Water sail marsh James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 DATE OF INSPECTION: ~'" Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1st day of construction ½ constructed Project complete, compliance inspection. INSPECTED BY: COMMENTS: James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Route 25, P.O. Box 1179 Southold, NY 11971 Telephone (631 ) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD TO: ""~'- ~---¢-~'1 ¢16ClL Please be advised that your application dated f/'~z~c~1 ! ~ m.~O/~ has been reviewed by this Board at the regular meeting of /]')¢~r-~r'; ,~!, o~,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) ½ Constructed ($50.00) X,x- 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 set fodh 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: $..~ ~-.~° ¢~6,~¢' !~q'5 BY: James F. King, President Board of Trustees James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino 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 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 Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hall Annex 54375 Main Road P.O. Box 1179 Southold, New York 11971-0959 Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OFTOWNTRUSTEES TOWN OFSOUTHOLD Permit No.: 7748A Date of Receipt of Application: March 19, 2012 Applicant: Robert Lehnert SCTM#: 137-4-23 Project Location: 905 Fleetwood Road, Cutchogue Date of Resolution/Issuance: March 21, 2012 Date of Expiration: March 21, 2014 Reviewed by: Trustee Dave Bergen Project Description: To add a new leaching pool landward of the existing. 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 site plan prepared by Robert Lehnert, received on March 19, 2012, and stamped approved on March 21, 2012. Special Conditions: None. 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 Bob Ghosio, Jr, Vice-President Dave Bergen Johll Bredemeycr Michael J Domino P.O. Box 1179 Southold. NY 11971 Telephone (631 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: o I ~: I0 A ,/-... ROBERT LEHNERT requests an Administrative Permit to add a new leaching pool landward of the existing. Located: 905 Fleetwood Rd., Cutchogue. SCTM#137-4-23 ~Se of area to be impacted: altwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: __~Chapt.275 Chapt. 111 other Type of Application: __ Wetland __Coastal Erosion __Amendment ¢-Administrative__Emergency Pre-Submission Violation Info needed: Modifications: Conditions: Present Were: J. King B. Ghosio '/' D. Bergen, J. Bredemeyer Michael Domino D. Dzenkowski Form filled out in the field by other Mailed/Faxed to: Date: Existing Cap,on existing leaching pool,. Photo showing mn-off from overflowing existing leaching pool. Photo showing proposed area of proposed new leaching pool. klAR 1 9 2012 N Jill M. Doherty, 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-I 892 Fax (631 ) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Applic~ati~on Wetland Permit Application ~ Administrative Permit ~ Amendm ent/Trans f, er/Elttensi6-n - t / LReceived Application: ][?~-Received Fee:$ ~'~-Completed Application .~j] Incomplete SEQR~ Classification: Type I Type II Unlisted Coordination:(date sent) /LWRP Consistency Assessment Form 3!1 q Il'>' CAC Referral Sent: --/~ate of Inspection: ..~Receipt of CAC Report: Lead Agency Determination: ~.echnical Review: "~Public Hearing Held: .~ Resolution: NameofApplicant )~Obef-]- /~r~t~r- 7/--- Address ~ 40 l/b/~'~5 ]~ ? A/-~'~/ PhoneNumber:( )~]]; ~]~- Suffolk CountyTax MapNumber: 1000- /77' ~ -23 Prop~y Location: ~ff~ ~/~ ~A ~ (provide LILCO Pole ~, dist~ce t~ ~oss ~r d location) (If applicable) Address: Phone: Board of Trustees Application Land Area (in square feet): Area Zoning: t{9-- ~ Previous use of property: Intended use of property: Covenants and Restrictions: GENERAL DATA Yes /X No If "Yes", please provide copy. Does this project require a variance from the Zoning Board of Appeals Yes ~/ No If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept. Yes X No Does the structure (s) on property have a valid Certificate of Occupancy /~ Yes No Prior permits/approvals for site improvements: Agency Date __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a govemmental agency? ~ No Yes If yes, provide explanation: Project Description (use attachments if necessary): ~ard of Trustees Applica~ WETLAND/TRUSTEE LANDS APPLICATION DATA Area of wetlands on lot: Percent coverage of lot: square feet Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No /~. Yes If yes, how much material ~vill be excavated? How much material will be filled? Depth of which material will be removed or deposited: Proposed slope throughout the area of operations: Mariner in which material will be removed or deposited: cubic yards cubic yards feet Statement of the effect if any on the wetlands and tidal waters of the town that may result b7 ~-eas0n of Su~-prop~d- ~)~p'e-~:~l~rt~ (US~ a~ta~e~s lf'~pp{~i~i-at~i - - - ~ROJECT ID NUMBER :~ART I - PROJECT INFORMATION 1. APPLICANT / SPONSOR 617.20 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 3.PROJECT LOCATION: 4. PRECISE LOCATION: Sb-eet Addess and Road Intersections, ~rominent landmarks etc - or provide map SEOR 5 IS PROPOSED ACTION: [] New [] Expansion [~Modification/alteration 6. DESCRIBE PROJECT BRIEFLY: 7 AMOUNT OF LAND AFFECTED: Initially #2~- acres Ultimately , ~. ~"" acres 8. WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? [~]Yes [] No If no, describe briefly: 9 WHAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) ~X'~ Residential [] Industrial [~ Commercial r-)Agriculture 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) ~Yes ~No If yes, list agency name and permit / approval: 11.1)Ub5 ANY ~ OP IHE ACTION HAVE /~-~"~qR~J~-Y VALID PERMIT OR APPROVAL? E~Yes [~o If yes, list agency name and permit / approval: 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT THE INFORMA PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE / Sponsor Na Date: S g.ature ;¢ '- I q .' l £ ~ ~'~ tC~he~action is a Costal Area. and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment Board of Trustees Application County of Suffolk State of New York 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 1N 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 TO'g/N TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. 1-N 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 Tj~IIS APPLICATj,ON. SWORN TO BEFORE ME THIS ]Q ~ DAY OF t'~qA' \ CJ~ ,20 Notary Public CONNIE D. BUNCH Notan/Public, State of New York No. 01BU61RY, nr, n Qualified in Suffolk County Comrniaaion Expire~ April 14, 20 1~- APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics omhibits conflicts of interest on the oart of town officers and emvlovees. The vuruose of this form is to vrovide information which can alert the town of possible conflicts of mtemst and allow tt to take whatever action ~ necessary to avoid same. (Last name, first name, &niddle 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.) 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 any officer or employee of thc 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 coq)oration in which the town officer or employee owns more than 5% oftbe shares. YES NO X If you answered "YES", complete the balance of this form and date and sign where indicated. Name of persen employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative) and the t~wn officer or employee. Either check the appropriate line A) through D) and/or describe in thc 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 corporst/on); B) the legal or beneficial own~:r of any interest in a non-cerporate 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 Submitted this / q _day of /~/ 20~ ~ Signature -~'~ --~'~'~ J/ Print Name K~'-~t'r ktr~'~/~ ~ ~ . ,~. vt T~wn of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Water~ont Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area (which includes all of Southold Town). If any question in Section C on tlfis form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus~ each answer must be explained in detail~ listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions, it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold ' s website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 137 4' - 3 The Application has been submitted to (check appropriate response): Tow. Bo~ra [] P'~n.in~oara[--] ~.~l~De~t. [~ Boa~o~Tr.stces Category of Town of Southold agency action (check appropriate response): (a) Action undertaken directly by Town agency (e.g. capital construction, planning activity, agency regulation, land transaction) (b) Financial assistance (e.g. grant, loan, subsidy) (c) Permit, approval, license, certification: Natureandextent°facfi°n:, ' d//t O Location of action: ~g:~ Site acreage: ,.~ ~'- Present land use: ~'91~'~FF~. Present zoning classification: If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name ofapplicant: /~-e'f ~L- ~r/~/7/~ (b) Mailing address: P/7~ff ////'l~r ~ /~rr~ t~ (c) Telephone number: Area Code ( ) (d) Application number, if any:_ Will the action be directly undertaken, require funding, or approval by a state or federal agency? Yes [] No [] If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III - Policies; Page 2 for evaluation criteria. Yes [--] No [] Not Applicable Aaach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [-~ Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III - Policies Pages 6 through 7 for evaluation criteria [] Yes ~ No [] Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LwRP Section III - Policies Pages 8 through 16 for evaluation criteria Yes No Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of Southold. See LWRP Section III - PoliCies Pages 16 through 21 for evaluation criteria Yes ~ No ~?(~LNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III - Policies; Pages 22 through 32 for evaluation criteria. Yes No ~ Not A~licable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III - Policies Pages 32 through 34 for evaluation criteria. [] Yes [] No ~ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria. Ycs D No Not Applicab,e PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III - Policies; Pages 38 through 46 for evaluation criteria. [--] Yes~ No ~ Not Applicable Attach additional sheets if necessary ~.ORKING COAST POLIC~ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III- Policies; Pages 47 through 56 for evaluation criteria. [-~ Yes ~-~ No ~ Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconie Estuary and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria. Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III - Policies; Pages 62 through 65 for evaluation criteria. ~-~ Yes [~ No ~ Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III - Policies; Pages 65 through 68 for evaluation criteria. [] Yes ~ No [~ Not Applicable TITLE: