HomeMy WebLinkAboutTR-7930E11/14/2812 82:58 G314778S~
ALBERTSON REALTY
PAGE 02/03
To: (3ardiners Bay Estates Homeowners Assoc atJon
From: Tom Aprea
Re: Dredging fill
This will authorize Gardiners Bay Estates H ameowners Assoclat~o~ to deposit the
material from the dredging of their channel to be Jeposlted on my property located at 500
Beach Court, East Marion, NY.
Tom Aprea /
Cc: CostelIo Marine
Southold Board of Trustees
SOUTHOLD TR'USTEES
Issued To~~~~,,~~
Address
THiS NOTICE MUST BE DISPLAYED DURING CONSTRUCTION
~/~ ////~//~
TOWN TRUSTEES OFFICE,TOWN OF SOUTHOLD
SOUTHOLD, N.Y. 11971
TEL.: 765-1892
James F. King, President
Bob Ghosio, Jr., Vice-President
Dave Bergen
John Bredemeyer
Michael J. Domino
Town H~I Annex
54375M~n Road
P.O. Box 1179
Southold, NewYorkl1971-0959
Telephone(631) 765-1892
Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
'~Coastal Erosion Permit Application
Wetland Permit Application
Amendment/Transfer/Extension
Received Application:
Received Fee:$
Completed Application
Incomplete
SEQRA Classification:
Type I .... Type I1 Unlisted
_Coordination:(date sent)_
LWRP Consistency Assessment Form
CAC Referral Sent:
Date of Inspection:_
Receipt of CAC Report:
Lead Agency Determination:
Technical Review:
._ Public Hearing Held:
Resolution:
Office Use Only
Administrative Permit
Name of Applicant
Mailing Address
~?'¢{
Suffolk County Tax Map Number:
Property Location:
(provide LILCO Pole #, distance to cross streets, and location)
AGENT:
(If applicable)
Address:
Phone:
of Trustees Applicati~
Land Area (in square feet):
Area Zoning:.
Previous use of property:
Intended use of property:.
GENERAL DATA
Covenants and Restrictions on property? Yes v~iNo
If"Yes", please provide a copy.
? )
Will this project require a Building Permit as per Town Code? __Yes ~ No
If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review
and Elevation Plans will be required.
Does this project require a variance from the Zoning Board of Appeals? __ Yes ~/No
lf"Yes", please provide copy of decision.
Will this project require any demolition as per Town Code or as determined by the Building Dept.?
Yes No
Does the structure (s) on property hayed valid Certificate of Occupancy? ~/Yes ~l~No
Date
Prior permits/approvals for site improvements:
Agency
__ No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspended by a governmental agency? __
If yes, provide explanation:
· ~No Yes
Project Description (use attachments if necessary):
/
of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations:
Area of wetlands on lot: square feet
Percent coverage of lot: %
Closest distance between nearest existing structure and upland
edge of wetlands: /x/o° ~ ~ feet
Closest distance between nearest proposed structure and upland
edge of wetlands: ~ A/~ feet
Does the project involve ~xcavation or filling?
No ~// Yes
If yes, how much material will be excavated?
How much material will be filled? ~
cubic yards
cubic yards
Depth of which material will be removed or deposited: ~ ~ ~ J feet
Proposed slope throughout the area of operations: o°/~r'77a '::3 tc~l
Manner in which material will be removed or deposited: ~ ¢¢/,~4~
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):
PROJECT ID NUMBER
PART I - PROJECT INFORMATION
1 APPLICANT/SPONSOR
3 PROJECT LOCATION:
Municipality ~:_. ~-).~/"~_~-~2L~ ~ //~ ~ .~
4 PRECISE LOCATION: Street Addess and Road Intersection.<
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
SEQR
County
Prominent !andmarks etc - or provide map
5 IS PROPOSED ACTION: [] New [] Expansion E~odification/alteration
6 DESCRIBE PROJECT BRIEFLY:
7 AMOUNT OF LAND AFFECTED:
Initially acres ,,~¢--~ Ultimately acres
8 WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
~Yes [] NO If no, describe briefly:
RAT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
esidential [~[ndustrial []Commercial []Agriculture E~Park/Forest/OpenSpace ~lOther (describe)
10.'DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
[~NO If yes, list agency name and permit / approval:
71. DOE/~' A~S~PECT OF~ACIiON HAVE A C~JRRENTL?~A~.i~) PERMIT or APPROVAL?
[~es E~]No If yes, list agency name and permit / approvak
12 AS ARE~ES~LT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
o
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
/ Sponsor e Date:
Signature ~0 ~/ / ~
If the action is a Costal Area, and you are a state agency,
complete the Coastal Assessment Form before proceeding with this assessment
Town of Southold
1 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
District Section Blcck Lot CERTIFIED BY A DESIGN PROFESSIONAl. IN THE STATE OF NEW YORK.
SCOPE OF WOILK - PROPOSED CONSTRUCTION ITI&N[# / WORKASSESSM~NT ] Yes No
a. What is the Total Area of the Project Parcels? I Will this Project Retain All Starr~Water Run-Off
(Inctade Total Area of all Parcels located within Generated by a Two (2") Inch Rainfall on Site?
the Scope of Work for Proposed Construction)
b. What is the Total Area of Land Cleadng (S.F. / ^c~s) (This item will include all run-off created by site
cleadng and/or construction activities as well as all
construction and/or Ground Distud~ance for the proposed activity? / {~S.F ? . impervious Site Improvements and the permanent creation of surfaces.)
2 Does the Site Plan andlor Survey Show Ati Proposed
PP, OVIDE BRIEF PROJEC'q' DESCRIPTION (P.~a, ~d~.~ Pap. N,~) Drainage Structures Indicating Size & Location? This
Item shall include all Proposed Grade Changes and
~ {¢~ O/e. ~ t.,t~ ~- ~ {+t.C..{~- ~ Slopes Controlling Surface Water Flow.
~o,o 'TSa-ck-~(.(-¢ 5~-,~. 3 Does the Site Plan andlor Survey descfibe the erosion
,t.~ and sediment control practices that will be used to
control site erosion and storm water discharges. This --
,~;;> ~j~O'-~E~ ~,o~_.~,r,~.~.. ~ ~.~:~<~ UemmustbemaintainedthroughouttheEntire
Construction Pedod.
i~ IJ~'0 I ~ (~4j[{7-~<~/~ ,~ ~ 4 Will this Project Require any Land Filling. Gradingor
~ /.~l.~i~.~4~)~u~_ 0/~.~' "~:>~C,~ Excavaben where there is a change to the Natural
Existing Grade Involving more than 200 Cubic Yards
{xO I'~/~/ t, Oc-~ <~K'C,-~P .~ ~) ~ ~ of Matedal within any Parcel?
~ 5 Will this Application Require Land Disturbing Activities
_c~ al~,c-/z ~ ~ ]~ ~/--~ ~-~ ~ '~ ~- 4~ Encompassing an Area in Excess of Five Thousand
.. .... ¢?._,. I ,O00S.F./Sg..reFe.tofGrouedSurface?
Ger~eral DEC SWPPP Requirements: or within One Hundred (100') feet of a Wet~and or
Submiss fen of a SWPPP is required for all Construction astivities involving sell Beach?
disturbances of one (1) or mom acres; including disturbances of less than one acre that 7Wilt there be Site preparation on Existing Grade Slopes
are part of a larger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen (15) feet of Vertical Rise to [
including ConsthJctlen activities involving soil disturbances of less than one (1) acre where One Hundred (100') of Hedzontal Distance?
the DEC has determined that a SPDES permit is required for storm water discharges
SWPPP'a Shall meet the Minimum Requirements of the SPDES General Permit 8 Will Driveways, Parking Areas or other impervious
cou ' .......
And that he/she is the 0 ~ ~ ~ 0 ~ ~o-o
Owner and/or representative of the Oyster or Owners, and is duly authorized to perform or have perfommd the said work and to
make and file this application; that all statements contained in this application are true to the best of his know~edge and belief; and
that the work will be performed in the m~umer set forth in the application filed herewith.
Sworn to before me this; ,,Q /,,Q ~
Notary Public: :-F~-~~ ................ xJ[Gg',J,,'f~-T.-~,~TOr~( .......
Nora Public ~'~ate ~ - ,~,..~,z. ....
FORM - 06/10
{~.alifim'l in ' Ik County
Commission Expires }ul¥ ..8 ~0 ?
\t..~
of Trustees Application
County of Suffolk
State of New York
"-~-l,9C~a~,_ 0~> ~c~ F~-~ 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 ANY AND ALL DAMAGES AND CLAIMS ARISING
UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN 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.
SWORN TO BEFORE ME THIS ,.~ / DAY OF 0 c-~
,20. (
Notary Public
VICKI TOTFI
Nolmy Public St~ate of New
No. 01}O~190696
Qua fed n SuffolkCoun Y .
Commissiop ~ xoire!: Iuv ?~; (
of Trustees Application
AUTHORIZATION
(where the applicant is not the owner)
(print owner of property)
residing at ~ff"e, z,
/o~ (mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Sou~ld3ard o f Town Trustees on my behalf.
(Owner's signature)
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics t)rohibits conflicts of interest on the oart of town officers and emDIovees. The vuroose of
this form is to on)vide information which can alert the town ofoosalble conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME:
(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 the To~n 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 7of 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 the Town of Southold
Title or position of that person
Describe the relationship between yourself(the appficanffagenffrepresentative) 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 thai apply):
A) the owner of greater than 5% of the shares of the corporate stock of the applic0nI
(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, parlner, or employee of the applicant; or
__D) the actual applicant.
DESCRIPTION OF RELATIONSHIP
Form TS 1
Submitted this ___day of 200
Signature
Print Name
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 si~Jfificant
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 detaii~ 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# (00t° _ 0~'~,0o_ 07.oo --~90~ .Oo /
PROJECT NAME
The Application has been submitted to (check appropriate response):
Town Board [--] Planning Board [--] Building Dept. ~] Board of Trustees
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:
Location of action:
Site acreage: ].~/~ ~
Present land use: ~c~t~d ~
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 of applicant:
(b) Mailing address:
(c) Telephone number: Area Code ( )b~2( '~ff~-l~,ff<2~ c__
(d) Application number, ifany: 6'3 / t-4 '7'7~- O~
Will the action be ~rectly undertaken, require funding, or approval by a state or federal agency?
Yes ~ No~LLJ 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.
Attach 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~ection III - Policies Pages 6 through 7 for evaluation criteria
[] Yes [] No 7] 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 Southoid. See LWRP Section III
- Policies Pages 16 through 21 for evaluation criteria
~ Yes UNo [5] Not Applicablc
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 LVOIP Section III - Policies; Pages 22
through 32 for evaluation criteria.
Yes No Not App~ole
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 anjfWastes. See LWRP Section III - Policies; Pages 34 through 38 for evaluation criteria.
Yes ['~[ No [] Not Applicable
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.
~ Yef--~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~_~ee/~arllP Section III - Policies; Pages 47 through 56 for evaluation criteria.
[] Yes [~ No I_~Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
E~Yes and Town waters. See LWRP Section III - Policies; Pages 57 through 62 for evaluation criteria.
~'~ No [] Not Applicable
Attach additional sheets if necessary
Policy 12. Protect agrifiaitural lands in the Town of Southold. See LWRP Section III - Policies; Pages
62 through 65 for eva~fiation criteria.
[-~ Yes [~ No[--~L--I Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III - Policies; P~ges 65 through 68 for evaluation criteria.
[ lYes I I Nol'~l NotApphcable
PREPARED BY ~Vr~ ~/9/LCTa TITLE DATE
Board Of $outhold Town T rustees
SOUTHOLD, NEW YORK
THOMAS 3. APREA, JR,
ISSUED TO ........................................ ' ....................................................................................
Pursuant to the I~OVld~m d Ch~pt*r 61~_ ~ ~ ~.~
tb St*~ of New Y~ ~3: ~ ~.~ d ~ ~ m ~
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~ ."R~U~NG ~D ~E ~ ~
IN ~ ~ TOWN WA~RS ~D ~ ~ ed ~
R~OVAL ~ SAND, ~L-OR O~ER ~A~A~ ~
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Re~ of ~e ~ a~ et · ~g ~ ~ .-~.:.---~-'-
.~0.~.__, a~ in ~derat~ of ~ ~ of $ ~.~9 ~ by
Goste~o Ma~tne ~ont~actin8 Gorp. ~or Thomas 3. ~ea,~r
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IN WITNESS WHEREOF, l~e ~ald
L. be subscribed by a 'mllomy Ot tim sam ooera
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VICI klITY MA?
LOCATION MAP
ADJAi~.C..N-'F pII. OPF-R.'I-y 01/vklF-1~,5:
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APPROVED BY
BOARD OF TRUST_'-ES
TO1/¥N OF $OUTHOLD
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