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Home My WebLink AboutTR-7785A James F. King, President Bob Ghosio, Jr., Vice-President Dave Bergen John Bredemeyer Michael J. Domino Town Hail 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 Permit No.: 7785A Date of Receipt of Application: May 4, 2012 Applicant: Alex Hillenbrand SCTM#: 115-11-23 Project Location: 50 Lupton Point Rd., Mattituck Date of Resolution/Issuance: May 16, 2012 Date of Expiration: May 16, 2014 Reviewed by: Board of Trustees Project Description: To abandon an existing sanitary system and install a new sanitary system further landward. 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 received on May 4, 2012 and survey stamped approved on May 16, 2012. 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 F.~King, PreC~ssid'd~ Board of Trustees SURVET' OF= PROPFRT'r' 5,1TUATE.. HA"I-FITI,~K TOi/~N.' ~X:::::~'I'HOI D 5L,TT, OLK ~TT', N'r' E~Ut~.VEYE. D O~-Ofa-2CK~5 ~UFFOL~ C~JN~ TAX ~* IC~)O - I1~ - II - 2~ NOTES: h'IONUI'dENT FOUND A~,EA = 2~,2EX2 S.F. O1~ O.5~ AC,~E GI:~.APHIC E~--.ALE I"= ~" - & 2012 N E , .,-'PROVED b ~' BOARD OF TRUSTEES TO~q~l OF SOUTHOLD DATE ~ I~lJ.'~ JOHN C. EHLERS LAND SURVEYOR 6 EAST MAIN STREET N.Y.S. LIC. NO. 50202 RIV-ERHEAD, N.Y. 11901 369-8288 Fax 369-8287 REF.-\~-Ip serverkt~PROS~05-222.pto Jmnes F. King, President Bob Ghosio, Jr, Vice-Presidenl Dave Bergen Johll Bredemeyer Michael J Domino P.O. Box 1179 Southold, NY 11971 Telephone(63[ 765-1892 Fax(631)765-6641 Southold Town Board of Trustees Field Inspection/Worksession Report Date/Time: ALEX HILLENBRAND requests an Administrative Permit to abandon existing sanitary system and install new sanitary system further landward. Located: 50 Lupton Point Rd., Mattituck. SCTM#115-11-23 Type of area to be impacted: __Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ~---~hapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion __Amendment ~Administrative__Emergency --Pre-Submission Violation Info needed: Modifications: Conditions: ,,~ Present Were: //&King B. Ghosio __J. Bredemeyer Michael Domino Form filled out in the field by j, /(,,,/X) ~.~ Mailed/Faxed to: Date: __ D. Bergen, D. Dzenkowski other 115 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 Office Use Only Coastal Erosion Permit Application/ ~Wetland Permit Application~Administrative Permit AmendmenVYraus fer/Extension .~'Rece~vved Application:.~ ] q! [~)- ~..~--Rcceived Fee:$ ~ ~..Go~pleted Application %~ LI ~ ~ Incomplete __SEQRA Classification: Type 1 Type II Unlisted Coordination:(date sent) ..,,'LWRP Consistency Assessment Form ~ ~ ~ ~'~- _ CAC Referral Sent: ,~}~ate oflnspection:- ~'-] q il ~' Receipt of CAC Report: Lead Agency Determination:__ Technical Review: --,,~ublic Hearing Held: .~.ll ~ [[~ Resolution: Name of Applicant Co ty 000- //'B3 (provide LILCO Pole ~, dist~ce to cross s~eets, ~d location) AGENT: (If applicable) Address: Phone: Board of Trustees Application Land Area (in square feet): GENERAL DATA Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions:__ If "Yes", please provide copy. Yes /~ No Does this project require a variance from the Zoning Board of Appeals __ If "Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as detennined by the Building Dept. Yes ~/ No Does the structure (s) on property have a valid Certificate of Occupancy L/'Yes No Yes [///No Prior permits/approvals for site improvements: __ No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended~.y_~ governmental agency? ~ Yes If yes, provide explanation: Project Description (use attachments if necessary): Jj~/~0 .~ Board of Trustees Applicatlon WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: /~/~//a~ ~! ~ Area of wetlands on lot: Percent coverage of lot: //5 feet Closest distance betwee.,~ne.~rest existing structure and upland edge of wetlands: _ ~)/~.2 feet Closest distance betwe;cn.nfare~t proposed structure and upland edge of wetlands: ]t~_ (./ feet Does the project involve excavation or filling? No /Yes If yes, how much material will be excavated? ,.~ cubic yards How much material will be filled? _~ cubic yards Depth of which material will be removed or deposited: ..~ 77 Proposed slope throughout the area of operations: feet Manner in which material will be removed or deposited: 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 attachments if appropriate): 617.20 SEQR 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 Appiicaflt or Project Sponsor) 1.APPLIC~NT/~SPONSQ~ / ,'7 , . ~ 12. PROJECT NAME 4. PRECI,%E LOCATION: Street Adde,~ and/~o, ad ~lntersections,~rpminent ~landmark~.,~ o~orovide _map IS PROPOSEB/ ACTION: [~w E~ Expansion E-~ Modification / alteration DESCRIBE PROJECT BRIEFLY: 7. AMOUNT OF LAND AFFECTED: Initially ¢, ,~ acres Ultimately ¢ ~ acres 8. WlL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ~YePs [] NO If no, describe briefly: 9 WH IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply) ~dential E~]lndustrial E~]commercial E~Agriculture E~]Park/Forest/OpenSpace E~Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) F~Yes [~No If yes, list agency name and permit / approval: lltUL)bS~N¥~SPECT-OF TRE~ACIION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~Yes [~No If yes, list agency name and permit / approval: R S eOF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? I CERTIFY THAT TH~ J. NFORMA~ON PROVIDED_ABOVE IS TRUE TO THE BEST OFMY KNOWLED Signature If the action is a Costal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PART II - IMPACT ASSESSMENT (To be completed by Lead A~lency) ! A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR, PART 6t 7.4? if yes, coo~:linate Ihe review process and usa the FULL FAF. ~lYes f~No ;B. V~qLLACT~NRC-c~VEC~RD~NATEDREv~EWASPR~v~D~DF~RUN~STE~ACT~NS~N6NYCRR~PART617~6? IfNo, anega~ ~ may be supetr, eded by another Involved agency. I-1 Ye' 171"o C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATEO WITH THE FOLLOWING: (Answers may be hane'wrlffe~, if legible) Cl. F_xis~ng ak quarry, sudace or gmungwator quality o~ quantity, noise levels, e~ng traffic paffem, solid waste produc~on or disposal, polenfal for erosion, drainage or flooding problems? F_xpleto t~ofl~: C~. Aesthetic, agricultural, archaeological, hlsto~ or o~fler natural or cuttural reaotmce~; or community or nelghbo~ood character? Explain briefly: C3. Vegetal;vii o~ fauna, fish, ~,heflfish or wildlife species, significant habitats, or h'estened or endangered species? Explain bdefly: C5. Growth, subsequent develop'm~nt, or rel~i~d ~ctivifes likely to be'tnduce~' by f~ proposed ac~len? Explain briefly: . _ ...... C6. Long term, shortterm, c~dmulati~iorothereffectsnotidenfified'i~"~l~C5? Explainbdefly: ..... c7. ot~r ~m~a~ ~ing ~n~ ~ usa ~'~imor qu~a~ Oii~e of ~F ~n t~e~Ic " PART Ill - Ot:l r-.~ieiATION OF SIGNIFICANCE (To be completed by A~ency) . IN~TRU~$: For each adverae effect identified above, determLqe whether It Is substantial, laege, Impertant or otflenetse stgnl6canL Each effe~ should be assessed Lq connection with its (a) setlLqg (i.e. uCoan or rural); (b) prol~bll'fff of eccunLqg; (c) duration; (d) krevemibllity; (e) geographic soope; and (0 magnitude. If neceasaQL add attachme~Lq or reference auRtx~rtLqg matedal~ Ensure ~ e~c~alaOe~s ~ootaln IKlffident de,u1 to r,l~v that all relevant ndvef~e Impacts have been identified ~ ~y ~. ff qUeS~on d of part Ii was ched~d yes, the dofermlnatiofl ofsignl~nce must evaluate Ihe pofe~al Impac~ of the proposed ac~kxt off the em~mental chafe. _ __,~_..__e~__ e~lhe CEA. detem~fon. · a~j verse enwronmemal ~n~oacts .~NO provue, ~ altachmeots as necessary, Ihe reasons supporting ~ Board of Trustees Name of Lead Agen~_cy Pdnt or Type Name of Responsible Officer in Lead Agency S~na[ure of Responsible O/~er in Lead Agency President Tife of Responsible Officer Signature of Preparer (If different fi'om responsible officer) Town of Southold ~ Erosion, Sedimentation & Storm-Water Run-off ASSESSMENT FORM ' pROPERTY LOCATION: S.C.T.M. #: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION OF A STORM-WATER, GRADING, DRAINAGE AND EROSION CONTROL PLAN otsfrict section Bh~k Lot CERTIFIED DY A DESIGN PROFESSIONAL IN THE STATE OF NEW YORK. WORK - PROPOSED CONSTRUuI1ON ri'laM # / WORKASSESSMENT [ Yes No SCOPE OF a. What is tho Total Area of the Project Parcels? (Ir~ctude Total Area of all Parcels located within I Will this Pr°ject Retain AIl St°rm'Watar Run'Off Generated by a Two (2') Inch Rainfall on Site? the Scope of Work for Proposed Constmcion) (This item will include all mn-off created by site b. What is the Total Area of Land Cleating (S.F.I AC~S) clearing and/or constnJcion activities as well as all -- and/or Ground Distudmnce for the proposed Site Improvements and the permanent creation of construction activity? impervious surfaces.) (S.F., Acres) 2 Does the Site Ptan and/or Survey Show All Propesed '~r~ PROVIDE, BRIEF PROJECT DESCRIFTION (P~'~-~:~'~ ~ - ~ Drainage Structures Indicating Size & Location? This ~/,.~ ~/./' ~X...~__..~ '~"~ ~ '('~/ Item shall include all Proposed Grade Changes and /6~ Slopes Controlling Surface Water Flow. / /,_....-~ ~.~5~O~ ~ . 3 DoestheSitaPlanand/orSurveydescdbetheerosion and sediment control practices that will be used to ! control site erosion and storm water discharges. This item must be maintained throughout the Entire Construction Peded. 4 Will this Project Require any Land Filling. Grading or~ Excavation where there is a change to the Natural I I Existing Grade involving more than 200 Cubic Yards~ __ of Matadal within any Parcel? 5 Will this Application Require Land Disturbing Activities ~ Encompassing an Area in Excess of Five Thousand (5,000 S.F.) Square Feet of Ground Surface? -- 6is there a Natura~ Water Course Running through the ~ Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirements: or within One Hundred (100') feet of a Wetland or -- Submission of a SWPPP is required for all Construction activities involving soil Beach? disturbances of one (1) or more acres; including disturbances of less than one acre that 7Will there be Site preparation on Ex[sting Grade Slopes ~l are part of a iotger common i~an that wis ultimately disturb one or more ac. res of land; which Exceed Fifteen (15) feet of Vertical Rise to I I including Construction activities invclving soil disturbances of less than one (1) acre where Orle Hundred (100') of Horizontal Distance? I~1 Ihe DEC has determined that a SPDES permit is required for storm water discharges. SWPPP's Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways. Parking Areas or other impervious Mr Stoma Water Discharges from Construcaon activity - Permit No. GP-0-t 0-00~.) Surfaces be Sloped to Direct Storm-Water Run-Off 1. ll~e SWPPP shall be prepared prior to the subn'Jttal of the NOI. T~m NOI shall be into and/or in the direction of a Town tight-of-way? 2. The SWP~PP shall despapa the erosion and sediment contrrfl practices and where 9Will this Project Require the P~acement of Material,~ V constructed to reduce the pollutants in storm wale* discharges and to assure Item Within the Town Right-of-Way or Road ShoulderL~ STATE OF NEW YORK, , f/z Z//~,~ ~Z~ COUNTY OF.. That I,. ~. ?.~mg duly sworn, deposes and says that he/she is the applicant for Permit, And that he/she is the ................................. ] ..(~_'~_~ ........................................................................................... (Owner, Co~hacfor. Agent, C, oqxlmts Officer, etc.) Owner and/or representative of the Owner or Owners, m~d is duly authorized to perform or have performed the said work and to make and file this application; that all statemen~t~ ~ht,~%0fl~l~l~application are true to the best of his knowledge and beliefi and that the work will be performed in the rn~/i~i~s~t~'- ~ Ik~lt~lion filed herewith. Sworn to b~f0re me this; ~ '~-" ~I~]-9~ST~61~?pO~8,,.. f .......... ...~.~..~...4/~.]~Z.~.~ay~.m.a.m.~g~u?.~!!~!!°.~..~..~ /~] /~ '~/~ //?/. /. ........................ FORM - 06110 Boar~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 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 SAID PERMIT(S), IF GRANTED. 1N 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 THIS APPLICATION. ~ignature SWORN TO BEFORE ME THIS DAY OF ,2o _ APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics nrohibits conflicts of interest on the Dart of ~own officers and emnlovees. The anmose of this form is to nrovide information which can alert tt~ town of nosalble conflicts ofintem~t and allow it to take whatever action is (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", nan3e the activity.) Do you personally (or through your company, spouse, sibling, parent, or child) have a relationship with any officer or employee of the 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 corporation in which the town officer or employee owns more than 5% of 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 d~e 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 beneticial 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 Signature Print Name __.day of 200 Town 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 Waterfront 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 this 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- suooorfing 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# / / '~--- / ( ~ 3 The Application has been submitted to (check appropriate response): TownBoar, [] Planning Board [] Bui,di;g'Dcpt. Vt oardofT. stees Category of Town of S outhold 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: ~-] Nature and extent of action: ~/~f~ ~ ~ ,~ Location of action: Site acreage: Present land use: 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: Co) Mailing address: (c) Telephone n : (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 thc 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 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southoid. See LWRP Section III - Policies Pages 3 through 6 for evaluation criteria [-~ Yes [] No [-~/NNot 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 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 [~Not 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 Applic~ 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 ~-~ot 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. Yes No [ NotApplicable 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 WORKING COAST POLICIES 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 [~ot 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. Yes [] No I~Not Applicable 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 ~M/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 ~/~ot Applicable ~<~ TITLE PREPARED BY DATE