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HomeMy WebLinkAboutTR-9471A Michael J. Domino, President ��o SufFOC��oGy Town Hall Annex John M. Bredemeyer, 111, Vice President 54375 Route 25 Glenn Goldsmith C.3 2= ql P.O. Box 1179 A Nicholas Krupski y • ��; Southold, NY 11971 Greg Williams �0� Telephone (631) 765-1892 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 1St day of construction / % constructed V When project complete, call for compliance inspection; Michael J.Domino,President 0f S0(/j�o Town Hall Annex John M.Bredemeyer III,Vice-President Q 54375 Route 25 O P.O.Box 1179 Glenn Goldsmiths[ Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9471A Date of Receipt of Application: June 5, 2019 Applicant: 1160 Snug Harbor LLC SCTM#: 1000-35-5-39.1 Project Location: 1160 Snug Harbor Road, Greenport Date of Resolution/Issuance: June 19, 2019 Date of Expiration: June 19, 2021 Reviewed by: Board of Trustees Project Description: Replace the chain-link fence running along the northwest corner of property with 36 high wood split rail fence; to replace the as-built 448 sq. ft. brick on- grade patio on west side of house in-kind; construct a 640 sq. ft. brick on-grade patio on south side of house 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 submitted by John Lupovici, received on June 5, 2019, and stamped approved on June 19, 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 S.C.T.M. NO. DISTRICT: 1000 SECTION: 35 BLOCK: 5 LOT(S):J9.1 a APPROVED BY -BOARD OF TRUSTEES TOWN OF SOUTHOLD DATE E STAKE U.P. STAKE 5.1's 00 '01 STAK % vol ... . ....... -26 . . ........ ... is.. ...... .. Fo 0, ............. ccs .:0 VO FLAGPOLE o do 'jo\ V., 0 W. 4* 'q U.P. ZONE X -S- C( 'ao� ELEC. METER 0 ZONE AE (EL 6) 0 12.5'N Ge, TIE LINES ALONG MHW UNE N 0,5 0 .7'N 03 C) N OCT 2 5 20118 EIA ;�o I i CN CN BANK -rop 0 61,011 S7g°09'38" 80091 811 UPDATE SURVEY 10-20-18 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL FIRM PANEL #36103C0176H LOCATIONS SHOWN ARE FROM FIELD OBSERVA77ONS AND OR DATA OBTAINED FROM OTHERS AREA: 38,881 .21 SQ.FT. or 0.89 ACRES ELEVATION DATUM- ------------- ------— UNAU77-IORIZED ALTERA77ON OR ADDITION TO 7HIS SURVEY IS A WOLA770N OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID 7RUE COPY. GUARAN TFES INDICATED HEREON SHALL RUN ONLY TO 77-IE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 77TLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITU77ON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARAN7EES ARE NOT TRANSFERABLE. 7HE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO 77-IE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT 7HE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADDITIONAL STRUCTURES OR AND 07HER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUffURES RECORDED OR UNRECORDED ARE NOT GUARAN7FED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF: LOT 32, P/O LOT 33, P/O RESERVED PARCI.1 INCL. CERTIFIED TO: JOHN LUPOVICI; JESSICA LUPOVI 1; MAP OF: CLEAVES POINT SEC. 2 ADVOCATE'S ABSTRACT, INC.; FILED: MARCH 13, 1962 STEWART TITLE INSURNACE COMPANY, SITUATED AT: GREENPORT TOWN OF: SOUTHOLD KENNETH Ni WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE # 17-177 SCALE: 1"=30' DATE: NOV. 28, 2017 - PHONE (631)298-1586 PAX (631) 298-1588 N.YS. LISC. NO. 050882 maintaining the records of Robert J. Hennessy & Kenneth M. Woychuk b.U.I.M. 5 LOT(S):39.1 S APPROVED BY 10253. -_- - BOARD O 1 RUSTEES — r __ OWN O OUTHOLD DAT JUN T Tvr� l Q�Zol� wso;��_ 5 �� G t^ TAKE _ t 1 I m UP01$ STAKE d �2 51dA -1-- �o 0 � F I J r� 6 f \ � \ mP 6 •$ �Q� 10 s 6+1� 0'N ZONE X ` c� �Up METER o ZONE AE (EL 6) / o � 73.5'N TIE UNES ALONG WNW LINE k^ + 3T\0 alfa o ro� ; 55� ad OAS 0.7N O S�0 y N zTop OF BPNK 61.01, UPDATE SURVEY 10-20-18 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL FIRM PANEL #36103C0176H LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 38,881.21 SQ.FT. or 0.89 ACRES ELEVA710N DATUM: ___ UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A WOLAT70N OF SECTION 7209 OF THE NEW YORK STATE EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTTTUAON LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE 774EY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77O,N OF FENCES, ADD177ONAL STRUCTURES OR AND 07HER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE TIME OF SURVEY SURVEY OF: LOT 32, P/O LOT 33, P/O RESERVED PARC17L INCL. CERTIFIED TO: JOHN LUPOVICI; JESSICA LUPOVICI; MAP OF:CLEAVES POINT SEC. 2 ADVOCATE'S ABSTRACT, INC.; FILED: MARCH 13, 1962 STEWART TITLE INSURNACE COMPANY; SITUATED AT: GREENPORT TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE 17-177 1"=30" NOV. 28, 2017 PHONE (831)298-1588 FAX (831) 298-1588 B SCALE. DATE: N YS. LISC. NO. 050882 —Intatnloi the record.of Robert E Henoewy A Ke—th M.ioychok Michael J. Domino, Presider SC - Towri Hall Annex . per. OGS, John M. Bredemeyer III,Vice-Presiaent �� ZJ, 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 ZZ A.Nicholas Krupski o Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: '/f 9 :Completed in field b J", dl p Y 1160 SNUG HARBOR LLC requests an Administrative Permit to replace the chain-link"fence running along the northwest corner of property with 36" high wood split rail fence; to replace the as-built 448 sq. ft. brick on-grade patio on west side of house in-kind; construct a 640 sq. ft. brick on-grade patio on south side of house. Located: 1160 Snug Harbor Road, Greenport. SCTM#: 1000-35-5-39.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� 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: I 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 modifications/conditions/need for'outside review/consultant/application completeness/comments/standards: g6ytf-W I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. 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OFFICE LOCATION: ®��®f S®U�iy®� MAILING ADDRESS: Town Hall Annex ® P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold,NY 11971 ® ® Telephone: 631 765-1938 Coum,� LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Michael Domino, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: June 14, 2019 Re: LWRP Coastal Consistency Review for 1160 SNUG HARBOR LLC SCTM# 1000-35-5-39.1 1160 SNUG HARBOR LLC requests an Administrative Permit to replace the chain-link fence running along the northwest corner of property with 36" high wood split rail fence; to replace the as- built 448 sq. ft. brick on-grade patio on west side of house in-kind; construct a 640 sq. ft. brick on- grade patio on south side of house. Located: 1160 Snug Harbor Road, Greenport. SCTM#: 1000- 35-5-39.1 A similar action proposed on the parcel was reviewed on February 16, 2018 and recommended as inconsistent with the LWRP. 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 on the new submittal and my assessment, the proposed action is recommended as CONSISTENT with the LWRP. 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 5f so Michael J.Domino,President Town Hall Annex AN, 54375 Route 25 John M.Bredemeyer 11L Vice-President P.O.Box 1179 Glenn GoldsmithSouthold,Now York 11971 as C.0 . ..... A.Nicholas Krupski Telephone(631) 765-1892 !N11 Greg Williams Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only qhDD E C E Coastal Erosion Permit Application I V E— Wetland Permit Application JUN - 5 2011 v"Administrative Permit Amendment/Transfer/Extens on Application: q Southold Town Board,of Trustees Received Fee:ecelve Completed Application: (P-51,L q Incomplete:. -SEQRA Classification: Type I_ Type H Unlisted Negative Dec. Positive Dec. —Lead Agency Determination Date, ,/ Coordination:(date sent):_ —�7--LWRP Consistency Assessment Form Sent- CAC Referral Sent: --k/ Date of Inspection: 7,104 Receipt of CAC Report: Technical Review: ]LPublic Hearing Held:::-:7:4��� Resolution: Owner(s)Legal Name of Property(as shown on Deed): �`oxt, A- LQ Mailing Address: Phone Number: Suffolk county Tax Map Number: 1000- Property Location: 1160 4ifi A (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: GENERAL DATA Land Area(in square feet): 1 Z Area Zoning: � ,+5 -- Previous use of property: 27=s� r,-nM 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? Yes No If"Yes", be advised this application will be reviewed by the Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes XC No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _--)�LNo Does the structure(s) on property have a valid Certificate of Occupancy? _Yes No 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?__)C No Yes If yes,provide explanation: Project Description(use attachments if necessary): ML - O— WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: q qp 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: •28 feet Does the project involve excavation or filling? X -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: y Manner in which material will be removed or deposited:, to kt P�s►+'� �C 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): 617.20 Appendix B Short Environmental Assessment Form Instruetions for Conipletin Part I-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 -; L 1 Name of Action or Project: Project Location(describe,and attach a location map): It60 S- 41-4 &�.. Brief Description of Proppsed Action: 1. PAST lf—^G 0Q_ JL4 e m CA( '_ 1\`^t= r-`tCA v14a-/_e-,9V"�// t����y ��.-r w+•� Z, %l V851 3. NtvI6_ ��v Sy pni;�, a— g, ��tsrt►t �c�.� - c� �r Name of Applicant or Sponsor: Telephone: (�•��� -Td,A,, A L,/pul tit E-Mail: 1jSL�.s�J • Gt1 Address: ,A p City/PO: 11 State: Zip Code: dvC—� c /V 1 ()O 1 v 1.Does the propo ed 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? 1V0 YES if Yes,list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? ��^acres b.Total acreage to be physically disturbed? ,01, acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? �. �- acres 4. Check all land uses that occur on,adjoining and near the proposed action. �� Urban El Rural(non-agriculture) ❑Industrial [—]Commercial E esidential(suburban) ❑forest OAgriculture ❑Aquatic ❑Other(specify): ElParkland Page 1 of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? b.Consistent with the adopted comprehensive plan? ❑ ®' ❑ 6. is the proposed action consistent with the predominant character-of the existing built or natural NO YES I landscape? El 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: 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? Z L1 c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 10 ❑_ 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: Rr ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? Z 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 waterboliies 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. tify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Iden Shoreline ❑Forest ❑Agri culturallgrasslands El 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.Wil l storm water discharges flow to adjacent properties? ❑NO ❑YES I V1 b.Will-storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO ❑YES 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 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: �-- 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/sponso e: �c��k� 3� -J t Cwt___ Date: /ail /I 1 Signature: Par 2-1 m ct Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following que ions,An part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or othe►}vJise 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 ❑ o regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? F] El 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or I+T affect existing infrastructure-for mass transit,biking or walkway? —l 6. Wil!the proposed action cause an increase in the use of energy and it fails to incorporate ❑ El reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: E a.public I private water supplies? ❑ b.public I private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ El architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? 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? 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,tong-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 an 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 AFFIDAVIT BEING DULY SWORN DEPOSES AND AFVIRMS 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 BOARD OF 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,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. 5 �/ Sib t of operty Owner Signature of Property Owner S TO BEFORE ME HIS 4 4 ` DAY OF ;•20 TAYLOR HERNANDEZ Notary Public-State of New York NO.01HE6377615 Otar P IIC Qualified in Nassau County y My Commission Expires Jul 9,2022 i APPLICANT/AGENT=I-PR'f',SENTATIVR TRANSACTIONAL DISCLOSURE FORM Tai '7oivn n Soto! 's Code of Et i ibis nfli t of i ter t o the of taw t rs. den to ecs.T r u oso 0 this f i o vide'nf ion wh c c ate t le.W' f oss'b1c c fI'c of in tallow it o tak t h er coon's nrrrec n_ t01VQid S1me. t , YOURNAME: a Lvr y 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" 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(southoldtownmorthfork.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# - /moo c- . PROJECT NAME, i 16® �� The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ 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: ,c "� 7 .. Location of action: 116o S,, .Site acreage: �)q Present land use: -OE � Present zoning classification: 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; Jy v L owJCA (b) Mailing address: YfL7-' Iya'y (c) Telephone number:Area Code (d) Application number,if any: A)f Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No E,%Ll 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 LYMP Section III—Policies; Page 2 for evaluation criteria. Yes F� No FJ Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LVVIl;P Section III—Policies Pages 3 through 6 for evaluation criteria ❑ Yes 11 No ZNot 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 F-1Yes ❑ No FNat Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No D 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 Yes F] �1 No 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 ] 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 Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substancesandwastes. See LWRP Section III—Policies; Pages 34 through 38,for evaluation criteria. ❑ Yes ❑ No U 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 LMW Section III.—Policies;Pages 38 through 46 for evaluation criteria. ❑ Not Ye� No U Applicable Attach additional sheets if necessary WORKING COAST POI IES 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. ❑Yes ❑ No Q 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 U Not Applicable 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(�ev�alluuation criteria. ❑ Yes ElNo!K Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; P ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY �� �.. �-�-t�a�t c --- TITLE __ DATES 3