HomeMy WebLinkAboutRamon, Barbe October 14,2005
Re: Pre-submission Inspection
Attn: Lauren Standish
Lauren,
I am requesting a Pre-submission Inspection to be conducted on my property,480 Rabbit Lane,East Marion,
tax map number,473889 31.-18-9. As discussed,this inspection is to occur on Novemberl",2005. I am
interested in determining whether this property is"build able"or the Trustees"jurisdiction"of this property.
Enclosed is a$50 check for the application fee.
Thank you for your help.
Sincerely,
V Y,
a e on
369 GARDEN STREET
EAST MEADOW, NY 11554
PHONE #516-582-7966
ICI OCT 1 9 2005 ;
Scutl old Toean
Board of Trustees
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CARDINERS
SURVEY OF BA.Y
PROPERTY
AT EAST MARION
TOWN OF SOUTHOLD
SUFFOLK COUNTY, N.Y.
1000 - 31 - 17 - 11 4�tih o, �-p
Scale 1" = 30"
June 23, 1988 '
Y.S. L/C, N0. 4966E
1 R EYORS, P.C.
'�020
P. OX 909 J.
MAIN ROAD
;, �. "firNn►n u v "91b2994999 PAGE.003
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Albert J.Krupski,President SO
Town Hall
James King,Vice-President 53095 Route 25
Artie Foster P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A. Dickerson Telephone(631)765-1892
l,Y`,ouffm Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Office Use Only
_Coastal Erosion Permit Application
_Wetland Permit Application Administrative Permit
—Amendment/Transfer/Extension
_Received Application:
_Received Fee•
et p�licatio
ncomplete
Type I Type II 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:
[� r
Name of Applicant --
n
Address �q � 5��1�,,t�� (a (( Ll
Phone Number:(516) 9�A
Suffolk County Tax Map Number: 1000 - L ��, q
Property Location: 900&) l 1•Al L
(provide LILCO Pole#, distance to cross streets, hd location)
AGENT:
(If applicable)
Address:
Phone:
Board of Trustees Application
GENERAL DATA
Land Area(in square feet):
Area Zoning: Qa Nkc m1 - '01 V
Previous use of property: as
Intended use of property: V
Prior permits/approvals for site improvements:
Agency D to
No prior permits/approvals for site improvements.
Has any permit/approval ever been revoked or suspen ed by a governmental agency?
No Yes.
If yes, provide explanation:
Project Description (use attachments if necessary):
Board of Trustees Application
WETLAND/TRUSTEE LANDS APPLICATION DATA.
Purpose of the proposed operations: - V)Fff &M i
Area of wetlands on lot: �� square feet
Percent coverage of lot:
Closest distance between nearest existing structure and upland
edge of wetlands: feet
Closest distance between ngarest proposed structure and upland
edge of wetlands: ` feet
Does the project involve excavation or filling?
_ V 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: feet
Proposed slope throughout the area of operations:
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):
Board of. Trustees Application
COASTAL EROSION APPLICATION DATA
Purposes of proposed activity:
Are wetlands present within 100 feet of the proposed activity?
No_ Yes
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)
Manner in which material will be removed or deposited:
Describe the nature and extent of the environmental impacts reasonably anticipated resulting
from implementation of the project as proposed. (Use attachments if necessary)
617.20 SEAR
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
f
3.PROJECT LOCATION:
Municipality , County U
4.PRECISE LOCATION: Street Addess and Road Intersections, Prominent landmarks etc -or provide ma
5.IS PROPOSED ACTION: F�/_;r New ❑Expansion ❑Modification/alteration
6.DESCRIBE PROJECT BRIEFLY: n,�
7.AMOUNT OF LAND AFFECTED: �aEInitially acres Ultimately acres n Q
8.WI PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS?
ZYes ❑ No If no,describe briefly:
"W AT IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.)
Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe)
10. DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL
AG NCY (Federal, State or Local) ��5 \�Ly
R]Yes ❑No If yes, list agency name and permit / approval: �]
11.DO S ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL?
Y Yes ❑No If yes, list agency name and permit / approval:
12. AS A RE JLT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION?
Dyes No
I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDG
Applicant /. Sponsor Name Date: l ��
Signature '�'b
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 Agency)
A. DOES ACTION E ED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAF.
0 Yes No
B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative
declaration may be superseded by another involved agency.
Yes 0 No
C. COULD ACTION RESULT IN ANY ANIERSE 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:
C4. A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly:
C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly:
C6. Long term,short term,cumulative,or other effects not identified in C1-05? 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
ENVIRONMENTAL AREA CEA? If es,ex lain briefl :
El
Yes �No
E. IS THERE,02 THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If es ex lain:
....... .. .. .............
ElYes No
I
PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency)
INSTRUCTIONS: For each adverse effect identified above,determine whether it is substantial,large,important or otherwise significant. 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(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain
sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked
yes,the determination of significance must evaluate the potential impact of the proposed action on the environmental characteristics of the CEA.
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 box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actin
WILL NOT result in any significant adverse environmental impacts AND provide, on attachments as necessary, the reasons supporting thi
determination.
Name of Lead Agency Date
Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer
Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from responsible officer)
NOTICE TO ADJACENT PROPERTY OWNER
BOARD OF TRUSTEES,TOWN OF SOUTHOLD
In the matter of applicant:
SCTM#
YOU ARE HEREBY GIVEN NOTICE:
1. That it is the intention of the undersigned to request a Permit from the Board of Trustees
to:
2. That the property which is the subject of Environmental Review is located adjacent to
your property and is described as follows: % MA `1b ' pRo
V
3. That the project which is subject to Environmental Review under Chapters 32, 37, and/or
97 of the Town Code is open to public comment on: You
may contact the Trustees Office at 765-1892 or in writing.
The above-referenced proposal is under review of the Board of Trustees of the Town of Southold
and does not reference any other agency that might have to review same proposal.
OWNERS NAME: Qvz�mc� l
MAILINGADDRESS: l,G -�c-nan A_m�t
PHONE#:
Enc: Copy of sketch or plan showing proposal for your convenience.
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CA RDINERS , l'
SURVEY OF BA Y
PROPERTY-
AT, EAST MA RION
TOWN OF .SOUTHOLD
SUFFOLK COUNTY, N. Y. .
1000 - 31 - 17 - 11 W�yy��A I w^�
Scale 1" = 30, o 0
June 23, 1988 „
NO. 4966E
1
RVEYORS, P.C.
f��•.... _OX 9 020
PROOF OF MAILING OF NOTICE
ATTACH CERTIFIED MAIL RECEIPTS
Name: Address:
3 &CL\L-QLQ-0 1�k
STATE OF NEW YORK
COUNTY OF SUFFOLK
residing at -,��Q
being duly sworn, deposes and says that the
�—day of a-200 , deponent mailed a true copy of the Notice
set forth.in the Board of Trustees Application, directed to each of the above named
persons at the addresses set opposite there respective names; that the addresses set
opposite the names of said persons are the address of said persons as shown on the current
_ assessment roll of the Town of Southold; that said Notices were mailed at the United States Post
Office at Qa�_ that said Notices were mailed to each of said personsQZj --
certi ie (registered)mail.
Sworn to be ore me this
Day of l 1i , 20A
Notary Public Keith Asdourian
Notary Public NY
030-4704103 Nassau Cty
Commission Exp 3.30-Ws J-YO'7
:a
r
Town of Southold
LWRP CONSISTENCY ASSESSMENT FORM
A. INSTRUCTIONS
1. 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.
2. 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 'fiug_ icant
beneficial and adverse effects upon the coastal area(which includes all of Southold Town).
3. 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-
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# - -
PROJECT NAME
The Application has been submitted to (check.appropriate response):
Town Board ❑ Plannin g Board ElBuilding Dept. ElBoard of Trustees
1. 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: d
Nature and extent of action:
Ajav ant
1 i F
Location of action: ) ` -
Site acreage. LO & —
Present land use:
Present zoning classification: &' kkm 1\ &
2. 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: o qftmc�n
(b) Mailing address: a o-_ 0 ill� o o
2aSa
(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 benef cial »�P a coas al location, and
minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation
criteria.
dyes ❑ No Not Applicable
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
Wr 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 .
12,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
u 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
El Yes ❑ '
No �- r 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 Applicable
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 RNot Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
s ubst nces and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
7Yes ❑ 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.
❑ Yer-1 No[dNot 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.
dyes ❑ No ❑ Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
❑ Yes ❑ No VNot Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages
62thhrrough 65 for evaluation criteria.
2t
►J Yes ❑ No❑ Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Sectio III—Policies; Pages 65 through 68 for evaluation criteria.
Yes ❑ No ❑ Not Applicable
PREPARED BYh2� Q0 DOLD �i Jp1t(��^All� TITLE DATE L2
Board of Trustees Application
County of Suffolk
State of New York
t BEING DULY SWORN
DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE
DESCRIBED PERMITS)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.
Signature
SWORN TO BEFORE ME THIS DAY OF 2000S
Keith Asdourian
:i�31 2- w
Notary Public NY
030-4704103 Nassau Cty
Commission Exp 3.3042O07
of ry Public
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of
this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is
necessary to avoid same.
YOUR NAME: PCJ r
(Last name,first nam ,.griddle initial,u1iless you are applying inthe 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
Exe tion from plat or official map Planning
it
(If"Other',name the activity.) Wavq n
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 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 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 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
Submitted t ' '3 day t 0 N, 200
Signature
Print Name l C3
Form TS 1
Albert J.Krupski,President ��� CD Town Hall
James King,Vice-President ti'Z` Gym 53095 Route 25
Artie Foster y P.O.Box 1179
Ken Poliwoda Southold,New York 11971-0959
Peggy A.Dickerson 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 Environmental 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: of Health Services
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
Board of Trustees_ Application
Jt
AUTHORIZATION
(where the applicant is not the owner)
I� residing .at
(print owner of property) (mailing address)
do hereby authorize
(Agent)
to apply for permit(s) from the
Southold Board of Town Trustees on my behalf.
(owner' s signature)
8
A _ 1
NOTICE OF PUBLIC HEARING §68-1
Chapter 68
NOTICE OF PUBLIC HEARING
§58-1. Providing notice of public hearings.
[HISTORY: Adopted by the Town Board of the Town of
f
Southold 12-27-1995 as L.L.. No. 25-3996. Amend_-uents
noted where applicable.] f
f
§68-1. Providing notice of public hearings. i
Whenever the Code calls for a public hearing, this section i
shall apply. Upon determining that an application is complete,
the board or commission reviewing the same shall fix a time
and place for a public hearing thereon.The hoard or commission F
reviewing an application shall provide for the giving of notice:
A. By causing a notice giving the time, date, place and
nature of the hearing to be published-in the official
newspaper within the period prescribed by law.
B. By requiring the applicant to erect the sign provided by i
the town, which shall be prominently displayed on the
premises facing each public or private street which the
property involved in the application abuts, giving notice
of the application, the nature of the approval sought
thereby and the time and place of the public hearing `
thereon. The sign shall be set back not more,than ten
(10) feet from the property line. The sign shall be
displayed for a period of not less than seven (7) days
immediately pteceding the date of the public hearing.
The applicant or his/her agent shall file an affidavit that
s/he has complied with this provision.
C. By requiring the applicant to send notice to the owners i
.of record of every property which abuts and every I
property which is across from any public or private street
§68-L
SOUTHOLD CODE §581
from the property included in the application. Such
notice shall be made by certified mail, return the receipt
e
requested,posted at least seven(7.)days prior hcation and
of the initial public hearing on the epp
d for them
addressed to the owners at the addr eagent shall
on the local assessment roll.The applicant or
file an affidavit that s/he has complied with this
provision.