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HomeMy WebLinkAboutGOLD, THEODORE TRUSTEES John M. Bredemeyer, III, President Albert J. Krupski, Jr., Vice President Henry P Smith John B. Tuthill William G: Albertson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road EO. Box 1179 Southold, New York 11971 June 11, 1993 Theodore Gold P.O. Box 1524 Southold, NY 11971 RE: SCTM %1000-51-4-10 Dear Mr. Gold: Your application has been reviewed and the property has been inspected by the Trustees. In order for the Trustees to proceed with their process, please provide this office with a detailed work plan for the proposed activities depicting what you plan to reconstruct and how you plan to dispose of concrete and other debris generated by your work. If you haVe any questions, please do not hesitate to contact this office. Very truly yours, rede President, Board of TrUstees JMB: j md TRUSTEES John M. Bredemever. III. President Albert J. Krupski, Jr.. Vice President Henry E Smith John B. 'Tuthill William G. Albertson Telephone (516) 765-1892 Fax (516) 765-1823 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SUPERVISOR SCOTT L. HARRIS Town Hall 53095 Main Road P.O. Box 1179 Southold. New York 11971 COASTAL EROSION MANAGEMENT PERMIT APPLICATION TOWN WETLANDS PERMIT APPLICATION TRUSTEE LANDS PERMIT APPLICATION Office Use Only: [z~oastal Erosion Permit Application ~4~etland Permit Application ,~yaiver from Chapter 97 ustee Lands Permit Application ¢~Grandfather Completed Apps. ~AC comments-Date: Sent Rec. ~ariance Required, -- ~%%~Neighbors notified Date: SEQRA Type ~oord. Review-opt.,mand. Insp. comp./date:~D~o~D-~ SEQRA Determin./date: Public Hearing/date: Findings: Permit Vote: {Y/N): Special Conditions: (also see file) Date Rec. by Office Application Fee: Application Number; SCTM $1000- ~/ -- ~/ ~ / Project Name (If any) Date Prepared: ~ )~ /~ Applicant~: ~-~ ~o~ ~% ~ OL~ Address: ~o~ ~&~ ~~0~~ A0~ ~o~o~ Phone Interest: (owner, consultant,lessee,etc.) Owner of Property: Address ~A~ Phone ( ) Subject Property Location: (Prc~v±de LZ'r.CO Pole ~, Distance to cross Streets if not: on location map) Page Yds. to be excavated: ~e ~ ~ Yds. to be filled: ~ Manner in which material will be removed or deposited: of canal, creek or bay fronting property: ~o~- Width Depth at low tide: Aver. rise in tide: Distance to nearest channel: -- Distance project extends beyond~similar projects in area: Area zoning: ~ ~ Land area in acres: ~/~ Is project for private or business use: Intended use of property: ~,~-~ Describe known prior operations conducted on premises: ----- Has any prior license or permit been issued to erect structures, dredge, or deposit fill on-said premises: ~ o Has any license or permit ever been revoked or suspended by a Governmental Agency: ~ 0 Project Description The project description must also include plans for reclamation of land disturbed during construction of the principle and accessory structures and underground structures (i.e., pipeline and septic syssem; make additional attachments if necessary). Authorization (Where the applicant is not the owner) I *'~-~ residing at (Print-owner of subject property) (Mailing address-phone) do hereby authorize to apply for Coastal Erosion permit(s)from the Southold Town Trustees Signature THIS IS NOT A PERMIT Page 2 County of Suffolk ) State of New York ) 0&Rod A ~iclc 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 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 REPRESENTATIVE(s), TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION~44ITH REVIEW OF THIS SI GNATURE .... ,t9~.3 .IOSEPfl CHEREPOWICH NOTARY PUBLIC, State of New York No. 4804615, Suffolk Coul~tY,~,, z Term E~pims September 30, 19 "1 Suggested space for location Map THIS IS NOT A PERMIT Page 3 "1.%*6-4,, f2/87~Text 12 i PROJECT LD. NUMBER 61¥~.~zl Appendix C State Environmental Quality Review .:' SHORT ENVIRONMENTAL ASSESSMENT FORM For UNLISTED ACTIONS Only PART f--PROJECT INFORMATION (-Fo be completed by Applicant or Project sponsor) SEQF 1. APPLICANT/SPONSOR I 2. PROJECT NAME 3, PROJECT LOCATION: 4. PRECISE LOCATION (Street address and road intersections, prominent landmarks, etc.. or prowae map) 5. IS PROPOSED ACTION: [] New [] Expansion [] Modification/alteration 7. AMOUNT OF LAND AFFECTED; Initially '--'~j~[¢' acres urtimately WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER EXISTING LAND USE RESTRICTIONS? [~es [] No If No. descrme briefly 9. WHr~A~,.[S PRESENT LAND USE IN VICINITY OF PROJECT? L.~,~Residential [] !ndustrial [] Commercial Describe: [] Agriculture [--~parklForestlOoen space [] Other 10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING. NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTALAGENCY (FEDERAL. STATE OR LOCAL)? I~] Ho If yes, l[st agen(~y(s] and permitlapprovals ~ ~ ~- ~ ~P ~ra O i~ L p~lo b j -'~ ~x} 11. DOES ANY ASr.~T OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? [~ Yes ~ ,HO If yes, lief agency name and permit/aPproval '12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/APPROVAL REQUIRE MODIFICATION? CERTIFY THAT THE INFORMATION PROVIDED ADOVE IS TRUE TO THE BEST OF MY KNOWLEDGE If the action is in the Coastal Area, and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment OVER 1 A. DOES ACTION E~) ANY'TYPE I THRESHOLD iN 6 NYCRR, PART 617.127 - If. yes, coeJ'~!ate the rewew pro,;ess ar~ use f';,~ EULL'~¢ [] Yes ~ No B. WILL ;ACTION RECEIVE COORDINA:rEE) REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCF~R, PART 617.67 ti No, a negattye declaration may be superseded by another involved agency. ' C. COULD ACTION RESULT IN ANy ADVERSE EFFECTSLASSOCIfATED WITH THE FOLLOWING: (Answers may be handwritten, if legible) C1. Existing air quality, surface or groundwater quality or quantity, noise levels, existing traffic patterns, solid,waste production or ~lsposa~. potential for erosion, drainage or flooding problems? Explain briefly:. [~' ~ ~ C2. Aesthetic, agricultural, archaeological, historic, or Other natural or cultural resources; or community er neighborhood character?. Explain C3. Vegetation or fauna, fish. shellfish or wildlife species, significant habitats, or threatened or endangered species? Explain briefly: C4. A community's existing plans or goals'as officially adopted, or a change in use or intensity of asa of land or other natural resources? Exblaln briefly C5. Growth. subsequent development, or r~lated aclivides likely lo be' induced by the proposed action? Exolatn briefly. . ....;'--.-:. ~'~ .......... Long term, short term. cumulative, or other effec~ts net identified in Cl-C57 Explain briefly. C7. Olher impacts (Jncl[Jding changes in use of e [her quanlity or ype of energy)~ Explain briefly. D. IS THERE. OR IS THERE LIKELY TO BE, CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL hMPACTS? [] Yes [] NO If Yes. exelain briefly ~ PART Ill--DETERMINATION OF SIGNIFICANCE (To be completed by Agency) INSTRUCTtONS: For each adverse effect identified above, determine whether it is substantial, large, important orotherw~se significant. Each effect should be assessed in connection with its (a) setting (i.e. urban or rural); (b) probability of occurring; (c) duration: (d) irrsvers~bility; (e) geographic scope; and (t} magnitude. If necessary, add attacRmentS or reference supporting mateNais. EnSure that explanations contain sufficient de[all tO Show that all relevant adverse impacts have been identified and Bdequately addressed. [] Check this box if you have identified one or more potentially large or significant adverse impacts which occur. Then proceed directly [0 the FULL EAF and/or prepare a positive declaration. [~]~heck this box if you have determined, based on the information and analysis above and any supporting documentation, that the proposed action.WILL NOT result in any significant adverse environmental impacts AND provide on attachments as necessary, the reasons supporting this determination: TRUSTEES John M. Bredemeyer, III. President ;dbe~ J, Kmpski. Jr.. Vice President Henry E Smith John B. Tuthill William G. Albenson Telephone (516) 765-1892 Fax I516) 765-1823 SUPERVISOR SCOTT L. HARRIS Town Hall : 53095 Main Road P.O. Box 1179 Southold. New York 11971 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 30 year Maintenance Agreement Erosion Protection Structures Chapter 37 Southold Town Code Southold Trustees as Administrator type or print name(s) the owners of record .of property at.: So¢~' ,~<' ..... Sd0[~/~-~'~-~ (type or print street~dress) SCTM ~t000- in applying for a Coastal Erosion permit for an Erosion Protection Structure do hereby agree to a 30 year maintenan.ce program for a structure commonly known as a ~A %~ ~ ad_ of ~-© as shoWn on the attached feet of length licensed survey of the as-built structure. It is my/our understanding that we are to maintain this structure with materials designed to endure 30 years and or equivalent to the original approved structure and that for any maintenance which involves more than 5% in length of this structure we are to give prior written notice to the administrator, waiting for their approval in all but true emergency situation's which Would seriously endanger life, property and important coastal natural resource features such as bluffs or wetlands'. We further understand that failure to maintain the structure could result in a requirement to post a bond and or have the repairs ordered as a lien against the property upon a finding by the Trustees that said lack of maintenance would risk life, property or important natural features resources includ' pro ected~ r~are r t etened animals and plants. Notarized Signature of owner of record SWORN TO BF~FORE ME THIS Term Ex~m, S~ptember 30, I9'~ Please submit three cop~es of a licensed land survey made within one year of the original construction. This maintenance agreement shall only be valid upon the final approval of the a~inistrator. S~se~ent owners may apply to the Southold Town Trustees to re-authorize this maintenance agreement. W