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HomeMy WebLinkAboutTR-9397A Michael J.Domino,President *OF SOUryO Town Hall Annex 54375 Route 25 John M.Bredemeyer III,Vice-President ,`O l0 P.O.Box 1179 Glenn Goldsmith J ]�[ Southold,New York 11971 A. Nicholas Krupski G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 COUNT`I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1580C Date: June 6.2019 THIS CERTIFIES that the trimming of three trees over power lines; one tree with branches ' over roof and top one tree(dead growth in upper part of tree); At 205 Private Road#3, Southold Suffolk County Tax Map#1000-70-6-9 Conforms to the application for a Trustees Permit heretofore filed in this + office dated January 14, 2019 pursuant to which Trustees Administrative Permit#9397A Dated March 20, 2019, 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 trimming of three trees over power lines; one tree with branches over roof and top one tree (dead growth in upper part of tree);. The certificate is issued to Renato & Carla Starcic owners of the aforesaid property. Authorized Signature Michael J. Domino, President ��OF SOUTjyO Town Hall Annex John M. Bredemeyer III,Vice-President ,`O l0 54375 Route 25 P.O. Box 11 Glenn Goldsmith #[ Southold, New York 11971 A.Nicholas Krupski G � O Telephone (631) 765-1892 Greg Williams10UU O Fax(631) 765-6641 �yNTY,�� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: -5,1) & Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain 1St day of construction '/z constructed �Z/Project complete, compliance inspection. INSPECTED BY: COMMENTS: CERTIFICATE OF COMPLIANCE: Michael J. Domino, President �o�pSUffo(�G Town Hall Annex John M. Bredemeyer, III, Vice-Presidento <' 54375 Route 25 Glenn Goldsmith P.O. Box 1179 A Nicholas Krupski Southold, NY 11971 Telephone 631 765-1892 Greg Williams � ��ol ,� ��t� P ( ) r � Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction, hay bale line/silt boom/silt curtain' 1 st day of construction %2 constructed When project complete, call for compliance inspection; a Michael J.Domino,President OF SOUry� Town Hall Annex John M.Bredemeyer III,Vice-PresidentO 54375 Route 25 ti O P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 cou�m,�' ' BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9397A Date of Receipt of Application: January 14, 2019 Applicant: Renato & Carla Starcic SCTM#: 1000-70-6-9 Project Location: 205 Private Road #3, Southold Date of Resolution/Issuance: March 20, 2019 Date of Expiration: March 20, 2021 Reviewed by: Board of Trustees Project Description: Trim three trees over power lines; one tree with branches over roof and top one tree (dead growth in upper part of tree). 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 project plan prepared by Suffolk Environmental Consulting, received on January 14, 2019 and stamped approved on March 20, 2019. 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. Michael J. Domino, President Board of Trustees SCDHS Ref. # Rf`0-05-0208 GREEK ; DOCK !_ " . E Ine o0 ,�•201O toe y8' Lj r 4.0' / � JAW 2019' C15 Zg, 610 f E��05 P q;,k-, C.P. • P�R"P� pG pia �n Squ!how loan E Board of Tra't"s 4P Jia '(0 1.0 r Cl 4.� a,I 0-1 ! h. Air CID �I '6• I` 10 50 SRP / ooa •p y j I N/()/F G'N� �' ,�. a6 OF . E• 0�oY 310 p23 0aklawn Ave. y3.pp\,I. •�'. L a X1. A p�bli fir \10, 6 I' N. 76•A8, WAY EgSE� Y ,n�'l y IGHT % w E R v8/. w zND s B' 0p' �9 _ 31.3' O 2 112 STY. ro { ` gk•Q i FR. HSE. Z W Pl,. ADW N !,ALS %NT fLt{.µ u \ 91) 31.4' 10.3' Q N. 3b f) p O ALL o 6 o _ / 1 �� o G 116.5 315 ( c>, o t Oaklawn Ave. z '.� �P �: '�� -ptbl,� ' wM WOut eX N 8 9737' . . N 2?.17 _ ?4-0 00 . . S T 0F ff,« _ AGN 50, R poAD #3 N 1p G Yea r.#. 3325 �E HYAjrT i /®/F oaklawn. AVe. �YN� CHARLES 0 TEs e0�eG � �IARDY Io/2o1e7 SURVEY ®F 0 PROPER TY $ HUMUS `! ROAD 4" DARK BROWN LOAM OL /`''6 T S®�,✓'TH-6LD �11 • � i PINE NEC BROWN SANDY LOAM SC e • " k! T® N OF S®(l TM0LQ t Well 0 � fli¢ AREA = 9,016,sq ft. BROWN LOAMY SAAP SC ' SUFFOLK COUNTY N. tO tie line 2.5' y LOT COVERAGE r PS E BROWN COARSE 1000_70_06_09 9Z,¢ sq.fi/9016 =. /0,2 /o C.P. WATER IN PALE BROWN el d.cv' 'SCALE. "-3®' COARSE SAND SW 17' MAY 127 2005 JUNi 17, 2010 ?addnrvris, i6l), !` by McDONALD GEOSCIENCE Feb /3 -toot �/�vfSions> _SEPT. 28, 2010 7PROP DECK The locations of wells and cesspools i I APRIL //,2006 (REVISION) I shown hereon are from field observations SeP� 22 200 s sf and or from data oblalned from others. g i NOV. 29, 2006 l WELL 1 AUG. 27, 2008 (founda(Ion) ' MAY 8, 2009 (FINAL B7H) I ¢ l am familiar wilh the STANDARDS FOR APPROVAL MAY 20, 2009 (UTIL. EASEA4ENT) LIAN, 27, 2010 (BASEMENT ELEVATION) AND-CONSTRUCTION OF SUBSURFACE SEWAGE JUNE 14 2010 (1inaU` DISPOSAL SYSTEMS FOR SINGLE FAMIL Y RESIDENCES NS€ I EL.15 and will abide by /he condi/ions set forth /herein and on the FIN FLA EL./3 FIN GRADE perm// lo-cons,# cl. 7E 11 rEri].B ST IE !E L.P. 10.3 _.=2�;cam"-';�I�G7'•/.sV>. I �i?' I FGno� �oN s �2o,><r �1�2M 10.3 10.0 `4,/ 9C- 310 %+ t?^, r,— ',w?a"v,`"• '; i ly, ANY ALTERATION OR ADDITION, TO THIS SURVEY IS A VIOLATION " h o-`�=.;;, t;,•,;'°', i; i ;_ OF SECTION 7209 OF THE NEW YORK STATE,EDUCATION LAW. SEPTIC SYSTEM CROSSECTIl�N EXCEPT AS PER SECTION 7209 - SUBDIVISION 2. ALL CERTIFICATIONS hiEREQN ARE •VALID FOR THIS MAP AND-COPIES'THEREOF ONLY,IF c '- t.,,: f„ Y,I$•r,, SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR WHOSE SIGNATURE APPEARS HEREON. • 4 , ,�,,;,. = !c ADDITIONALLY TO COMPLY WITKSAID LAW-TERM - ALTERED-BY :PECON%C'SURVEYORS;-P.C; MUST BE USED BY ANY AND ALL�SORVEYORS UTILIZING A COPY (631,1 765 - 5020 FAX (63/1�765>= I797 OFMOTHER SURVEYOR'S MAS. TERMS SUCH ' INSPECTED - AND P. 0. B'OX 909 BROUGHT - TO - DATE ARE NOT IN COMPLIANCE WITH THE LAW. A STAKE 1230 TRA"VELER STREET SOUTHOLD, N Y. lf9'7l' �-� tea. , P•4IIt i,i Tree Trimming Schematic — Starcic 205 Private Rd #3, Southold (nts) J N.75'35'50"E' Snu!haltl To,^m ,__ Boar i of 9� -ZO • P AG* 3.02 Approximate location of tree p w S.Slimbs to be trimmed over cL power lines on north side of i.•afp house. rj• O O(V-A' b�SAN _ ppt,E Approximate location of deac 4'. ti upper portion of tree to - -� be cut located on west side of house. D 31.3' 2.1/2 STY. \owl Ffi. HSE. WD1V Approximate location of 5A�9 T tree limbs to be trimmed over east side of house. RET• O a ' 31.4` - , L0.3'_ LL 30- --_ _ APPROVED BY . `IOARD OF I R,USTEES 0 5i, N a :. TOWN-OF SOUTHOW •LP cp DATE. Irnq, Zoe 2f'!q Michael J. Domino, R snt o�QSc � Town Hall Annex John M. Bredemeyer III, Vice President �� �,,, 54375 Route.25 Glenn Goldsmith y P.O.Box 1179 ze A.Nicholas Krupski -Pry Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES -TOWN OF SOUTHOLD Date/Time: f�% �� Completed in field by: Suffolk Environmental Consulting on behalf of RENATO & CARLA STARCIC requests an Administrative Permit to trim three trees over power lines; one tree with branches over roof and top one tree (dead growth in upper part of tree). Located: 205 Private Road #3, Southold. SCTM# 1000- 70-6-9 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet, 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 ✓ Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modIifications/conditions/need for outside review/consultant/application completeness/comments/standards: r I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other rill•- `a� - t Photo • • • to be trimmed over • •- • house. (Photo 1by Property Owner) Photo depicting tree limbs to be trimmed over power lines on north side of house. I rN,�-. (Photo taken 10/15/18 by property Owner) " f (pp(yyrr it tt t gy(y�•L,: �:i�': �,,[ 1c F� ' ell {� �° y,� •�` r• '. • Jµt 14 y� Tl d }y,cT C t y'f,`' - 7� �•�• JI •` 't. ��L�; ,, .iy`�'. 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O2 ,•,,,, --•-- """' --•-- Real Properly Tax Service Agency Y eeP +n om G r.... a..� --r-- t..ru. cartp.um,.RN.nr...NY„f8t N 070 E e r —_— tr.+w --t-- n..W--•-- @ A ,nerNm NO ,005 ,N �� '� rtiW --•-- r”"--�^-- °�" P WS e]s PROPERTY MAP D ...r. a r t _____ -- tnNt3aut aue.tinar 2,Atcl -- OFFICE LOCATION: SO �® MAILING ADDRESS: Town Hall Annex AZ P.O.Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) 4 Southold, NY 11971 Y� Telephone: 631765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, LWRP Coordinator Date: March 12, 2019 Re: LWRP Coastal Consistency Review for RENATO & CARLA STARCIC SCTM# 1000-70-6-9 Suffolk Environmental Consulting on behalf of RENATO & CARLA STARCIC requests an Administrative Permit to trim three trees over power lines; one tree with branches over roof and top one tree (dead growth in upper part of tree). Located: 205 Private Road #3, Southold. SCTM# 1000-70-6-9 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, the proposed action is recommended as CONSISTENT with the LWRP provided the Board considers: Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney John 1Y1.Eredemeyer III,Presidentc3^ to s_ ' Town Hall Annex Mic bacl#l.Domino,Vice-Pre9iident t'f ; 54376?Main Road P.O.Box 117: James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee , Charlea J.Sanders,Trustee ' Telephone(631) 765-1892 r (631)765-6041 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit Amendment/Transfer/Extensio Ifl Received Application: , Received Fee:$ PUa�o _-._.'.A° Completed Application: 2 ' Incomplete: - ! SEQRA Classifica Type I Type II Unlisted , 1 Coordination:(date sent) LWRP Consistency Assessment Form: CAC Referral Sent: Date of Inspection: 3.�2�/ Receipt of CAC Report: Lead Agency Determination Technical Review: Public Hearing Held: Resolution: Name of Applicant Renato and Carla Starcic Address P. O. Box 1445, Southold,NY 11971 Phone Number: 2( O1 ) 376-7429 Suffolk County Tax Map Number: 1000-70-06 -09 Property Location: 205 Private Road#3 - Southold -New York (provide LILCO Pole#, distance to cross streets, and location) AGENT:_ Bruce A. Anderson- Suffolk Environmental Consulting Inc (If applicable) Address:_ P.O. Box 2003; Bridgehampton NY 11932 Phone: (631) 537-5160 Board of Trustees Application GENERAL DATA Land Area(in square feet): 9016 s.f. Previous use of property: Residential Intended use of property: Residential . Covenants and Restrictions: Yes X No If"Yes",please provide a copy. Will this project require a Building Permit as per Town Code? Yes X 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 X No If"Yes",please provide a 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? X Yes No Prior permits/approvals for site improvements: Agency Date Trustees Permit#6327(house) 3/26/06 No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency X No Yes If yes,provide explanation: Project Description(use attachments if necessary):Applicant Proposes to trim three trees over Power lines, one tree with branches over roof and top one tree (dead growth in upper part of tree) (See schematic for location of the trees)_ Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purposes of proposed operations:_ Increase safety to house Area of wetlands on lot: 300 square feet(±) Percent coverage of lot: 10.2 % Closest distance between nearest existing structures and upland edge of wetlands: 0' (dock) feet Closest distance between nearest proposed structures and upland edge of wetlands: N/A feet(Proposed Deck) Does the project involve excavation or filling? X No Yes If Yes, how much material will be excavated? N/A (cubic yards) How much material will be filled? N/A (cubic yards) Depth of which material will be removed or deposited: N/A feet Proposed slope throughout the area of operations: N/A Manner in which material will be removed or deposited: N/A 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): No impact to the wetlands are anticipated because the applicant seeks only to trim trees to remove potential threat to power lines and the dwelling. Short Environmental Assessment Form Part 1 -Project Information Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please.answer as thoroughly as possible based on current'information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information Name of Action or Project: Renato and Carla Starcic Project Location(describe,and attach a location map): 205'Private Road#3,Southold,NY 11971 Brief Description of Proposed Action: Applicant proposes to trim three trees over power lines,one tree with branches over roof and top one tree(dead growth in upper part of tree) (See schematic for location of the trees Name of Applicant or Sponsor: Telephone: 201-376-7429 Renato and Carla Starac E-Mail: Address: P.O.Box 1445 City/PO: State: Zip Code: Southold NY 11971 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that ❑✓ ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? 0 2 acres b.Total acreage to be physically disturbed? 0 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0 2 acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial mResidential(suburban) ❑Forest ElAgriculture ❑Aquatic ❑Other(specify): ❑Parkland Page 1 of 3 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ FV1 ❑ b.Consistent with the adopted comprehensive plan? ❑ 71 ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ ❑✓ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify:Jockey Creek(tributary to Peconic Bay) ❑ ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES ❑✓ ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ❑ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑✓ ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ✓❑ ❑ b.Is the proposed action located in an archeological sensitive area? W1 1 ❑ 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? ❑ b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional ® Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? 7 ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ❑NO YES - b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: NO AYES Page 2 of 3 18.Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: ❑ ❑ 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: Z ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spQnse nam y 4L. YS�"� Date: Signature: Part 2-Impact Assessment. The-Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? LJ 0- 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ L] 3. Will the proposed action impair the character or quality of the existing community? El 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? El 1:1 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? El D- 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ (� reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: EJ ('�uI a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, [�") (� architectural or aesthetic resources? {�l �j 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, {� waterbodies,groundwater,air quality,flora and fauna)? El Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? El I Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. ❑ Check 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. Town of Southold-Board of Trustees Name of Lead Agency Date President 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) PRINT Page 4 of 4 Board of Trustees Application County of Suffolk State of New York Renato and Carla Starcic , BEING DULY SWORN DEPOSES AND - - AFFIRMS -THAT WE ARE THE APPLICANTS 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. r Renato S rcic Carla Starcic SWORN,TO BEFORE ME THIS DAY OF a-)KbD✓ ,20LL ,e CHRISTOPHER M TOSADO m' Notary Public—State of New Jersey My Commission Expires Jul 17,2022 Notary Pu Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) We, Renato and Carla Starcic residing at 205 Private Rd.##3 (P."0. Box 1445) Southold,New York, 11971 do hereby authorize Suffolk Environmental Consulting, Inc. to apply for permit(s)from the Southold Board of Town Trustees on our behalf. c Renato St is C-04 L:== Carla Starcic CHRISTOPHER M TOSADO Notary Public—State of New Jersey 022 My Commission Expires Jul 17,2 ora���c,►c. Sr�r-c.��UewSzr5� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of the 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: Starcic,Renato and Carla (Last name,first name,middle initial,unless you are applying in the name of someone else of other entity, such-as a company.If so,indicate the other person's or company's name.) NATURE OF APPLICATION. (Check all that apply.) Tax grievance Building Variance Trustee X Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Plannmg i 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 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 X 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 applicantlagent/representative)and the town officer or employee.Either check 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 then 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 thi day of A E G���— 2�11 _ Signare O Print me Renato and Carla Starcic Form TS 1 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORINT 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. Bruce A.Anderson (Last name,first name,middle 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 X 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 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 X 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 ' 12a` dav of Januarv.2019 ���A Signatu Print Name Bruce A.Anderson Form TS 1 PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS Name: Address: STATE OF NEW YORK COUNTY OF SUFFOLK Bruce A. Anderson, residing at Suffolk Environmental Consulting, Inc, P. O. Box 2003, Bridgehampton,NY 11932, being duly sworn, deposes and says that on the day of , 2017, 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 their 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 Bridgehampton, that said Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Sworn to before me this Day of , 20 Notary Public NOTICE TO ADJACENT PROPERTY OWNER BOARD OF TRUSTEES, TOWN OF SOUTHOLD In the matter of applicant: Renato and Carla Starcic SCTM# 1000 — 70 — 6 — 09 YOU ARE HEREBY GIVEN NOTICE: 1. That it is the intention of the undersigned to request a Permit from the Board of Trustees to conduct regulated activities: Applicant proposes to trim three trees over power lines one tree with branches over roof and top one tree (dead growth in upper part of tree) (See schematic for location of the trees). 2. That the property which is the subject of Environmental Review is located adjacent to your property and is described as follows: 205 Private Road Rd #3 - Southold • New York 3. That the project which is subject to Environmental Review under Chapters 96, 111 and/or 275 of the Town Code is open to public comment on: DATE: 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. PROPERTY OWNERS NAME: Renato and Carla Starcic MAILING ADDRESS: P. O. Box 1445 • Southold • NY - 11971 PHONE #: (201) 376 - 7429 AGENT: Bruce A. Anderson (aD- Suffolk Environmental Consulting Inc MAILING ADDRESS: P. O. Box 2003, Bridgehampton NY 11932 PHONE #: (631) 537 - 5160 Enc: Copy of sketch or plan showing proposal for your convenience. T T1__ rro 1 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 significant 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",then the proposed action may affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus,the action should be analyzed in more detail and, if necessary,modified prior to making a determination that it is consistent to the maximum extent practicable with the LWRP policy standards and conditions. 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# 70 - 6 - 9 The Application has been submitted to (check appropriate response): Town Board ❑ Planning Dept. ❑ Building Dept. ❑ Board 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: Nature and extent of action: A1212licant proposes to trim three trees over power lines, one tree with branches over roof and top one tree (dead growth in upper part of tree) (See schematic for location of the trees). Attach additional sheets if necessary rr Location of action:' 205 Private Rd 93 • Southold•New York• 11971 Site acreage: 0.2 acres Present land use: Residential Present zoning classification: R-40 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: Renato and Carla Starcic (b) Mailing address: P. O. Box 1445 • Southold •NY • 11971 (c) Telephone number: Area Code(201 ) 376-7429 (d) Application number, if any: N/A 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? 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 Subiect proposal would properly be classified as exempt by LWRP Coordinator 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 Subiect proposal is not applicable to this policy in that it will have no impact to any potential historic and/or archaeological resources within the surrounding area. 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 5 through 7 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Subject proposal would properly be classified as exempt by LWRP Coordinator Attach additional sheets if necessary r NATURAL LICIES 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 Subject proposal will fully comply with Policy 4 in that the trimming of trees would protect the power lines and house 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 Subject proposal is not applicable to this policy in that it will have no effect to the water quality/supply within the surrounding area 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 There is no relationship between the proposed protect and the policy. 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 Subiect proposal is not applicable in that the proposal will not result in any form of adverse effects to air quality, Accordingly, this proposal is not applicable with this policy. 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 ® Not Applicable Subject proposal is not applicable in that the proposal does not involve disposal and/or transportation of solid waste hazardous waste, toxic pollutants petroleum products Attach additional sheets if necessary 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 Subiect proposal is not applicable to this policy in that the proposal is attendant to a private residential use Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependence uses in suitable locations. See LWRP Section III—Policies;Pages 47 through 56 for evaluation criteria ❑ Yes ❑ No ® Not Applicable Proposed prosect has no effect on water-dependent uses. 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 ® Not Applicable Subject proposal is not applicable in that the proposal does not involve any form of marine resource management (i.e. commercial fisheries, recreational fisheries aquaculture etc ) 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 Subject proposal is not applicable in that the proposal does not involve agricultural lands 0 a the conversion of farmland, the establishment and/or maintenance of new coastal agricultural production- etc ) 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 Subiect proposal is not applicable in that the proposal does not involve the conservation of energy resources on a commercial level and/or the promotion of alternative energy sources proper maintenance of fuel storage facilities and/or the extraction of mineral extraction Attach additional sheets if necessary Created on,5/25/05 11:20 AM