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HomeMy WebLinkAboutBurnham, Bradford R John Bredemeyer, President SUFFo1,.c Town Hall Annex Michael J. Domino, Vice-President ��° ��s 54375 Route 25 James F. King ti P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�o! ,p �a Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: Mary Burnham on behalf of R. BRADFORD BURNHAM requests a Wetland Permit to construct a single-story 15.5'x33.4' detached garage with basement, a wood entry ramp; and gutters to leaders to drywells. Located: 2464 Peninsula Road, Fishers Island. SCTM# 10-3-4.1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: Chapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes No Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: Modifications: Conditions: Present Were: J. Bredemeyer M. Domino J. King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by Mailed/Faxed to: Date: Bradford nyya �. 2464 Peninsula Road,Fishers Island • ,,.L •♦ 't •`• V��p�M� a ,�.• :. s •'ate,.- ;��� �••y•���� �,• ,f • rye •�A� �►:•••�� d,`�M `� � '� / t •I��� I i�!-.�' •�•!- s� •a � •!�Ji �7'!i\ !azo , tier•.. may' , �' `�". ' +P r: - � �s WT.- 07- 15. 6k •Cr'�. v`" K• >: P '4k �� e +r rJ arta! "'�• • 1 ;k _.h..s ire _ ' '[`_ , +i►=._.±� �j as`•, a ^- • a�¢���•`�" •• y'. �� t - .rte .•;. -1 $�: n �. ��t. � -��• �,��. .z. 'f� _,ice. �.. to ,� a. •�+ * .!!'..T ' • .. .r. 'tel • �tgw •_�' - , •r.r :a- - - _,t.. ,_ .- ./'. ...� - 'rte• i ' ,R.Bradford Burnham �2464 Peninsula Road,Fishers Island "t` r �• `A�, '� '} w(` *�"�t `+ r Vis' ; . ,i. 777" 1 t. '� S .. �' r j� A �! moi. j +�� �y ' Yl� ~ `•- ~ !. r 17 it � � ' A1C _ / �< .� �����` ,j f• 14s ��. ink ♦T � ., r.�:.i� .-1, '.SSA - -`,/`< ..� _ r., �'�( _ Iv r -• ._�-' r' �� - •i. �r '*1 ♦.- .. � '' � -' s � Y�'` .�/' � � / ,. .. `'�' +t �;..►,, A� ;'w' +.yam a - � - 4 12 09 '10;;'28,,<2.0 1. �� AlOr 'MF •... w ',, p 1�h..R, • h ` r y j�f W `', r•: • .w yf'..A q�yys} X _' air 40 _ -- .� ` � � �•tp/' �.. � _ � - ice- �_: ;j�•� .. ,,. i NN 1-4 AVW �' � i " -. , .!��*� � e.\�, .,f` � .� � �•, �. �,� /� Imo"� � - "; r10%2814 12 . 09, s John Bredemeyer, President �oguFFot,tTown Hall Annex Michael J. Domino, Vice-President ��° °°s 54375 Route 25 James F. King P.O. Box 1179 Charles J. Sanders • Southold, NY 11971 Dave Bergen y�o! ,� �a°� Telephone (631) 765-1892 Fax (631) 765-6641 Southold Town Board of Trustees Field Inspection/Work Session Report Date/Time: pG`f alwell Mary Burnham on behalf of R. BRADFORD BURNHAM requests a Wetland Permit to construct a single-story 15.5'x33.4' detached garage with basement, a wood entry ramp; and gutters to leaders to drywells. Located: 2464 Peninsula Road, Fishers Island. SCTM# 10-3-4.1 Type of area to be impacted: Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code proposed work falls under: ­ hapt.275 Chapt. 111 other Type of Application: Wetland Coastal Erosion Amendment Administrative Emergency Pre-Submission Violation Notice of Hearing card posted on property: Yes ',-/N o Not Applicable Storm Water Management Review: Yes No Not Applicable Info needed: o ecti/ % .��-®�C �-� � � 57/9-r/ ®tJ Modifications: Conditions: Present Were: J. Bredemeyer I M. Domino King C. Sanders D. Bergen Bay Constable Other Form filled out in the field by /x3 6- Mailed/Faxed to: Date: r' e ` - k a e AA- -*. -4w qt •- k' dr s * , sryAEL +� or TT lk 77 'm LON , c 4 . - x Q ' A, . a ; 144 WP 11u�'u 1 , — — ° x t t�lcl + BEE BEC MO Oox � _ xia two wf MI4B., 1�f I _wTOn _Z_ xti �Pa MG, a� N "a m � , ° ; ..�.:• � BFF BEC Nl); xM \ mxdJLOt ^ x0J00 ,�r`` � •1. 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Kt ao 1000 PROPERTY MAP • Nao-• P ts, ,\19 Sol, John M.Bredemeyer III,-President 4 Town Hail Annex All 54375 Main Road Michaelj.Domino,Vice-President P.O.Box 1179 James F.King,Trustee Southold,New York 11971-0959 Dave Bergen,Trustee Te_lephone(631)7654892 0 Charles J.Sanders,Trustee , Fai(631)_-766-6644 - ouo 'BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD f7, Office Use Only Coastal Erbsion,Permit,Ap plication OCT 2 3 2014 IL VWbtIA4d3,P'6,iliiit'Aoplicati6ti, _,Administrative Permit 'Amendment/Transfer/Extension V'Received Applicatibii:V/ V �fTrfl Trustees -Aornpleted,Applicationeceived Fee:$_4� `ZC _-_�/ j01�3 � —1.ncomplete SEQRA Classification: ' Type I Type e 11 -Unlisted , — oqrdj,n&ion:(date,sent) _V__.,,CW RP Consistency Assessment Form >� Lead Agency Determination: Technical Review: _�OPublicHearing keld:_Jjj,, Resolution:, 'Name ofApplictmt Mailing Address PZ1V_Q1A5Q2.4 P?,Ie9 FCA- Phone Number:( Suffolk County Tax Map N4rnber: 1000- 10 Property Location: ZLj--1 'Pe Q LA E6 F-15 NLY (provide LILCO.Pole#, distance to cross streets, and location) (If applicable) Address: -LII-F �/m— 37777 -Phone: Board of Trustees Application GENERAL.DATA Land Area(in square feet): 24�, 34 f fr . Area Zoning:_?____10 Previous use of property: ZE5/Pgwa<' Intended use of property: Covenants and Restrictions on property? Yes No If"Yes'-',please provide a copy. Will this project require a Building Permit as per Town Code? X—Yes No If"Yes",be advised this application will be reviewed by the Building Dept. prior to a,Board of Trustee review and Elevation Planswill be required. Does this project require a variance from the Zoning Board of Appeals? _Yes No If"Yes",please provide copy of decision. Will this project re, uire ny demolition as per Town Code or as determined by the Building Dept.? Yes __e No Does`the structure(s)on property have a valid Certificate of Occupancy? Yes No f , i� J' Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? No Yes,",.= If yes, provide explanation: Project Description(use attachments if necessary):�JQek l Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: tiJ��',(/Cj /V Q Area of wetlands on lot: o D .__ Square feet Percent coverage of lot: % ,Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: _feet Does the project involve excavation or filling? ; No Yes If yes,how much material will be excavated? 300 cubic yards How much material will be filled? a cubic yards Depth of which material will be removed or deposited: feet o � Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: 4UD �Edv�� o UN �tJr� SND R*; -1tt&-7JT C E N97V 6,4 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): TTL 7'y Ny E� lSQ.�UTICIL°��i' FeYV�JP 7b TRV- Ne 617.20 Appendix B Short Environmental Assessment Form Instructions for Completing Part l -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. Par't„1-Project�and Sponsor Information Name of Action or Project: - �ivlNSvG.�t . Project Location(describe,and attach a location map): P Brief Description of Proposed Action: c0-AJSTPVCY7&AJ Cf=' ,4 N eL4./ 7(N 5tolit r PET/fet5-t7p �RG$/ 19eAzr A'L is Lv(nt -if3b\-A4d--VT: Name of Applicant or Sponsor: Telephone:a1'��' 6 ��x Rc<, E-Mail: Address: �70 wM7 3 7M SWV UT N77t City/PO: State: Zip-Code: k)tw YoIQK /U lovlg 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: 3UJJ,V(n-4- 129WR rzu&4,�), Dec 3.a.Total acreage of the site of the proposed action? _ acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? —V/--acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban 'Rural(non-agriculture) ❑Industrial ❑Commercial ❑Residential(suburban) ❑Forest ❑Agriculture 0Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. is the proposed action, NO, YES N/A a. A�permitted use under the zoning regulations? ❑, EJ b.Consistent with the adopted comprehensive plan? ❑ ; /� t❑� 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ N 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; j--1 54 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO J YES _Ili ❑ b.Are pub Iic,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 ofthe proposed action? I- El 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:�p _�LU (/� ❑ 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? .� ❑ 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: 3�1 ❑u 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? 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? 5NO YES ❑ b.Will storm water discharges be directed to established conveyance systems(ru off and storm drains)? If Yes,briefly describe: '25NO DYES Page 2 of 4 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 ofthe proposed action or an adjoining property been the location of an active or closed NO __YES solid waste management facility? If Yes,describe: 20.Has the site of We proposed action or an adjoining property been the subject of remediation(ongoing or NO YES. completed)for.hazardous waste? If Yes,describe: 1'AFFIRM THAT THE INFORMATION-PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST-OF'MY KNOWLEDGE Applicant/sponsorname: Date: Signature;; ; Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part Z Answer all of the following questions in Part 2 using the information contained in Part I and other materialssubmitted 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 Q regulations? 2. Will the`proposed action result in a change in the use or intensity of use of land? .__ rt � ' 3. Will the proposed action impair the character or quality of the existing community? ( � lQ 4. Will the proposed action have an impact on the environmental characteristics that caused the nu establishment-of a Critical'Environmental Area(CEA)9 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? ❑, 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? El 7. Will the proposed action impact existing: EJ (—} a.public/private water supplies? L�1 b public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ — architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e,g.,wetlands, F1 Elwaterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 I 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? 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.mayor 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. c j� Check this box if you have'determined,based on the information and analysis above,and any supporting documentation, t 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 ]_ d of Trustees Application County of Suffolk State,of New York 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. Signaturq of Property Owner SWORNTO BEFORE ME THIS ZZ`"- DAY OF cz:�C;Wn ,201 r MARICELA WAS Notary M tic-State of Mehr Yak jAA�� NO.O1 SA6147603 CWftd in New York C Notary Public My Commission Expires e , Board of Trustees Application AUTHORIZATION (where the applicant is not the owner) I, � A � �residing"at (print owner of property) (mailing address) 1Sci ,�5 1 do hereby authorize (Agent) MAR--Y F(.1ANM:M to apply for permit(s)from the 3 Southold Board of Town Trustees on my behalf. (Owner's signature) 4 APPLICANT/AGENT/REPRESENTATIVE j TRANSACTIONAL DISCLOSURE FORM t . 1 The'Cown ofSouthold's Coda of Ethics prohibits conflicts of interest on the Hurt of town gfficcrs and emnlovae Thea�urlsose of this form is to provide infori-oatibn and aliow•it.to.tal.e whatever detfou is_ necessary to avoid same. ,. ! YOUR NAME: U AMA R. `• (Last name, irstrifirrie,.q»ddle 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.) Taxrievance Building g -- Variance a Trustee ! Change of Zone Coastal Erosion Mooring Approval of plat g t Exemption from plat or official map Planning Other (If"Other",name the activity.) Do,you persaiially(W1hrougfi;yotsr ccmpany,.spousc,sifilitigparent dr child)have a relationship with any officer or employee of the'I own of Southold? "Relationship"includes by bintsd,marriagex or business interest."Business'interest"means a business, inciudiit�.R,pnrttie'rship,>iix Which.'the to�yu officer or employee has even-it partial ownership of(or employment by)a corporation in which•ihe town'of�icer'ur employee owns more than 510 of the shares. YES NO _ — I If you answered"YES",complete the balance of this form and date and sign where indicated. z' Name of person employed by the Town of Southold 1' Title or position of that parson Describe the relationship between yourself(the applicant/aggnt/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): Aj the owner of greater than 5%of the shares of the corporate stock of the applicant 1 (tivhen the applicantisn corporation); I3)ihe:tegal or)ieneficial owner ofatty interest in a non-corporate entity(when the ' applitrant is nota corporation); C)on iafficer,"director,pprtne,'or employee of the-applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this 22day of 4 40 Signature AA Print Name M,A P•� bVfL 1Jjt f Form TS I Town of Southold ' Erosion; Sedimentation 8l: Storni-Water Run-off ASSESSMENT FORM ? � PROPERTY LOCATION: S.c.T,M.1f: THE FOLLOWING ACTIONS MAY REQUIRE THE SUBMISSION-OF A >O , STORM-WATERS GRADING,DRAINAGE AND EROSION CONTROL PLAN str ct ec�wn -ii oT cF- — of t CERTIFIED BY A DESIGN PROFESSIONAL iN THE STATE OF NEW'YORK. SCOPE OF WORK - PROPOSED CONSTRUCTION ITEM# / WORK ASSESSMENT Yes No a. What is the Total Area of the Project Parcels? I Will this Project Retain All Storm-Water Run-Off (Include Total Area of all Parcels located within U 134 3/ s Generated by a Two(2")Inch Rainfall on Site? the Scope of Work for Proposed Construction) [�(S.F./Acres) (This item will include all run-off created by site b. What is the Total Area of Land Clearing clearing and/or construction activities as well as all and/or Ground Disturbance for the proposedO Site Improvements and the permanent creation of construction activity? (s,f•./Acres) impervious surfaces.) 2 Does the Site Plan and/or Survey Show All Proposed PROVIDE BRIEF PROJECT DESCRIP'T'ION (Provide Additional Pages as Needed) Drainage Structures Indicating Size&Location?This Item shall Include all Proposed,Grade'Changes,and 90 C/',o�[�-rp V�+.�1.f1 , D N.r_ ! Slopes Controlling Surface Water Flow. ,5— 1t L!l.��WV O -j 3 Does the.Site Plan and/or Survey describe the erosion and sediment control practices that will be used to X e control site erosion and-storm water discharges. This item must be maintained throughout the Entire (�i Construction Period. X -5 x33 ^ ` `X _f t/ '4 WIII this Project Require any Land Filling,Grading or Excavation where there is a change to the Natural Existing Grade Involving more than 200 Cubic Yards of Material within any Parcel? 5 Will this Application Require Land Disturbing Activities Encompassing an Area in Excess of Five Thousand (5,000 S.F)Square Feet of Ground Surface? '16 Is there a Natural Water Course Running through the Site? Is this Project within the Trustees jurisdiction General DEC SWPPP Requirementsor within One Hundred(10b')feet of a Wetland or Submission of a SWPPP is required for all Construction activities Involving soil Beach? disturbances of one(1)or more acres; Including dlsturtiances of less then one acre that 7 Will there be Site preparation on Existing Grade Slopes are part of a Iarger common plan that will ultimately disturb one or more acres of land; which Exceed Fifteen(15)feet of Vertical Rise to ess including Construction activities involving soil disturbances of lthan one(1)acre where One Hundred(100')of Horizontal Distance? II.��.��.�� the DEC has determined that a SPDES permit Is required for stone water discharges, (SWPPP's§hall meet the Minimum Requirements of the SPDES General Permit $ WillDriveways,Parking Areas or other Impervious ' for Storm Water Discharges from Construction activity-Permit No.GP-0-10001.) Surfaces be Sloped to Direct Storm-Water Run-Off 1.The SWPPP shall be prepared prior to the submittal of the Not.The Not shall be into and/or in the direction of a Town right-of-way? - submitted to the Department prior to the commencement of construction activity 2_The SWPPP shall describe the erosion and sediment control practices and where 9 Will this Project Require the Placement of Material, required,post-construction storm water management practices that will be used and/or Removal of Vegetation and/or the Construction of any constructed to reduce the pollutants in storm water discharges and to assure Item Within the Town Right-of-Way or Road Shoulder compliance with the teens and conditions of this permit In addition,the SWPPP shall Area?(This Item will NOT Include the Installaaon of Driveway Aprons.) ; identity potential sources of pollution which may reasonably be expected to affect the i quality of storm water discharges. NOTE: If Any Answer to Questions One through Nine Is Answered with a Check Mark g 3.All SWPPPs that require the post-construction storm water management practice In a Box and the construction site disturbance is between 5,000 S.F.&1 Acre In area, i component shall be prepared by a qualified Design Professional Licensed In New York astorm-Water,Grading,Drainage&Erosion Control Plan is Required by the Town of that Is knowledgeable in the principles and practices of Storm Water Management. Southold and Must be Submitted for Review Prior to Issuance of Any Building Permit. (NOTE- A Check Mark(j)and/or Answer for each Question is Required fare Complete Application) SPATE OF NEW YORK, COUNTY OF...N..� ...�otP .........SS That I,.. r ., JI"" ..being duly sworn,deposes and says that he/she is the appl15a-d (Name of indiviid/duual signing Document) j And that he/she is the /�G>rGw.?!................................................................................................................. _ s (Owner,Contractor,Agent,Corporate Officer,etc) Owner and/or representative of the Owner or Owners,and is duly authorized to perform or have performed thd ; make and file this application;that all statements contained in this application are tete to the best of his knowle ;01 that the work will be performed in the manner set forth in the application filed herewith. e ' Sworn to before me this; m .... -z .... ...................day of. --t�J !e{2.......... ,20,E-+ �Notary Public: .... ,.5:7�^�. ,. ,� =••-•••:•=•........................... Gsr[•-•. .. .... .:... $ `.��,`r (Srgnalure of Applicant) . FORM - 06/10 g 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 ofSoutholdLocal Waterfront'Revitalization Program. A proposed action will be evaluated as to its siQx ificant- beneficial and adverse effects uRon the coastal area(tiyhich 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 M. 1ainM'in detail, listing both supporting and non-, sunportinj�facts. If an action cannot be certified as consistent with the LVW, '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 /A/ND1PROPOSED ACTION SCTM# - .3 - r PROJECT NAME P,f,M&_6Q L-d RO_� G The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept; 9' 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: GON UCr76N ®P AL1W / 1�Z Location of action: Siteacreage:, 6 lirke5 Present land use: e3/lE1774L Present zoning classification: R'"_ (� 2. If an application for the proposed action has been filed with the Town of Southold agency, the following informa 'ion shall be provided: (a) Name of applicant: /AJA'R y 'j()Rp#M (b) Mailing•address: _5Z �� f LO AJOA1 KOkK NY Oo f (c) Tele hone number: Area Code( ) a--1 a--_70-�� � _....... (d) App ication number,if any: Will'the action be-directly undertaken,require funding,or approval by a state or-federal agency? Yes Q 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 beneficial use of a coastal location,-and minimizes adverse effects of'development. See LWRP Section III—Policies; Page 2 for evaluation criteria. to Yes 0' No [:] Not Applicable S w/7? VC W Attach additional s eets if necessary Policy 2. Pro ect and preserve historic and archaeological resources of the Town of Southold. See LWRP SectioIII—Policies Pages 3 through 6 for evaluation criteria F1 Yes ED, 9 Not Applicable G I 1 Attach additional sheets if necessary Policy 3. Enance visual ,quality and protect scenic resources throughout the Town of Southold. See LWRP Section%II—Policies Pages 6 through 7 for evaluation criteria 59 Yes No: Not Applicable v Gw W - , Arlt v az9t t°. ee77. -c> ?= 014—t- 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 84hrough 16'for evaluation.criteria Yes No O'NotApplicable (S 70 Get I Attach'additional heats if.necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pagi s 16,through 21 for evaluation criteria Yes No ZNot Applicable nwf-s S 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. E1 fK 1 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' D No V<] Not Applicable s or /&-7- 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. QYes F=1 No lCl 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. © Ye�] No K Not Applicable i rp 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. Fl Yes U NoX Not Applicable c T 1c w ` Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the P,econic (E�s`t�uary and Town waters. See LWRP Section-III—Policies; Pages 57 through 62 for evaluation criteria. 1---1,YesEl No,9 Not•Applicable ` d�� l AQ �MF 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. `I Yes 0 No L'O-/J Not Applicable U 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. _F Yes ,[ No LN Not Applicable PREPARED BY TITLE DATE Transmittal 22 October 2014 Re: Fishers Island Garage To: From- Town of Southold John Mealy Board of Town Trustees jmealy@mbbarch.com Town Hall Annex 54375 Main Road Page 1/1 Southold, NY 11971-0959 Enclosed 1—Original plus three (3) copies completed Wetland Permit Application 2—Original plus,three (3) copies project drawings 3—(4) Sets current photos of existing site 4—(1) Survey 9 of existing site I� 5—Wetland permit application fee ($250) OCT 2 3 2014 Dil � Bo rd f Trustw___. Please find enclosed for review an application package for a propose new residential garage on Peninsula Ro Fishers Island. hank you, John Mealy (mealy@mbbarch.com 212-7658-7676 x13 1 Murphy Burnham&Buttrick 48 West 37th Street Teiephone 212 768 7676 Architects New York,New York 10016 wv w.rnbbarch corn