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HomeMy WebLinkAboutTR-9468A I p��SufFQ(,I President COQ Town Hall Annex Michael J. Domino, G�, John M. Bredemeyer, III, Vice-President ;��� y� 54375 Route 25 Glenn GoldsmithN ,z P.O. Box 1179 A Nicholas Krupski a y • o�,� Southold, NY 11971 Greg Williams X01 „� �� � 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 When project complete, call for compliance inspection; Michael J.Domino,President �Qf soar Town Hall Annex John M.Bredemeyer III,Vice-President �� y�l 54375 Route 25 h O P.O.Box 1179 Glenn Goldsmith [ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 �lyC4UNf`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9468A Date of Receipt of Application: April 29, 2019 Applicant: Robert Serling SCTM#: 1000-86-2-10 Project Location: 3575 Wells Road, Peconic Date of ResolutionlIssuance: June 19, 2019 Date of Expiration: June 19, 2021 Reviewed by: Board of Trustees Project Description: Construct a 25'x25' picnic area using 2" RCA base, top dressed with 3/8" natural stone, with 4" metal edge to frame and nine (9)flat topped boulders for sitting; 6'x6' on-grade bluestone patio with stepping stones for entranceway; construct 2 or 3 courses of 4"x4" cedar secured by rebar at seaward end of picnic area. 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 Robert Serling, received on April 29, 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 Michael J. Domino,Preside J ��S � Town Hall Annex John M. Bredemeyer III, Vice-President ��O G2� 54375 Route 25 Glenn Goldsmith ! C3 P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: �/ qam Completed in field by: ROBERT SERLING requests an Administrative Permit to construct a 25'x25' picnic area using 2" RCA base, top dressed with 3/8" natural stone, with 4" metal edge to frame and nine (9) flat topped boulders for sitting; 6'x6' on-grade bluestone patio with stepping stones for entranceway . Located 3575 Wells Road, Peco ic. CTM#: 1000-86-2-10.&p5ed 0- �Ce' C CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 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 SE QRA 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 modifications/conditions/need for outside review/consultant/application completeness/comments/standards: I \1—$ w s a ;-n- 19,- ct;eA c�— C ma r/ V^ )C-1 11 r> Ne 10 Aelaza� ie.,7 g7 r I lK—r�ovs��d�6� -�' '�� q.► ' � 'oma � c� (�I . 1 have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other I i t i SCDHD REF # R10-17-0015 SURVEY OF PROPERTY A T PECONIC m� TO WN OF SO UTHOLD 0 0 0 SUFFOLK COUNTY, N. Y. 11>0 '1'Fjc ' DW SF,oy M 1000-86-02-10 \-'- 4c \ ac &A�FRl FEBRUARY 11, 2014 X) qr ; SL+ AUG. 28, 2014 (PROPOSED ADDITION) s0 co a o co"c yUA� JUNE 15, 2015 (REVISIONS) Qpm i v�vE yam• h* So' '� FR APRIL 7, 2096 (REVISIONS) `- ,f �ry ^�• ° s2?. spur NOVEMBER 07, 2017 (FOUNDATION LOCA770N) v '2s o� 18 (FINAL) SyO� yr'14/Z DECEMBER 14,PCA pe JANUARY 3, 20190(REVISIONS) 10. o. 5 3 I DW ol �'Z: APR 2 9 2019ROI PCRCH co ry (ho 1p STAIRS 7q / �• �-� t �,_ � p• a �s8. �^� � ,� ►wry own"c DW� STONE PATIO O� \ DW SCREENED PORCH SEMI-ENCLOSED DW X = STAKE = WETLANDS FLAG 9 RF PROPANE EDGE OF WETLANDS, AHWM & ALWM BY JMO �Fjy s TANK / 3 ENVIRONMENTAL CONSULTANTS CF *TIDAL WETLANDS STAKED 3/16/2015 �0� - All 0 FIELD WORK WAS COMPLETED WITH 8" OF SNOWscy /6- t shF° .ham �` �1.MEp�� COVER. WALKWAYS NOT SHOWN HEREIN. G.o� ��g ELEVATIONS REFERENCED TO N.A.V.D. 1988 sG f FLOOD ZONE FROM FLOOD INSURANCE RATE MAP MAP NUMBER 36103CO162H SEPTEMBER 25, 2009 . LIC. NO. 49618 ANY ALTERA770N OR ADD177ON TO THIS SURVEY IS A WOLA77ON o�20`' PE ° P.C. OF SECTION 7209OF 174E NEW YORK STATE EDUCA7TON LAW. 00`` 3 ,eG� GFMq� 631 '4�ZX 631 765-1797 EXCEPT AS PER SEC77ON 7209—SUBDIVISION 2. ALL CERTIFlCA77ONS AREA=167419 SO. Fr. ti 'SFyO �yFs°� P O. BOX 909 ( , HEREON ARE VAUD FOR THIS MAP AND COPIES 7HEREOF ONLY lF �, qo SAID MAP OR COPIES BEAR 774E IMPRESSED SEAL OF 774E SURVEYOR TO TIE LINE 1230 TRAVELER STREET 14-002 WHOSE SIGNATURE APPEARS HEREON. SOUTHOLD, N.Y. 11971 VT ff """..�wr.....w. `` ray •.,, 4�. `r � 1 wy � t . 1 � � 1 r t,_ t _ s , r• „y ` . 4 hs •'�.•�(��T � �n:� �< ;"�e4• C i�X �;�^ f� 1+1 YlJry_;JI,�S' �r t'' �. y ' ,r r .a" iy _^ 9�L:- 4K-x� z, � ,� .�� x ,�s ��4„}:d � rte.' µ• �r r r l� �� Zara 'y fK�, ti _ �. ,y � i � t' �.�_y •, � I-,'F�..�.y (f/" � a����- y _ yy� Y ti' ,,•�rr,�l r,a-t „F, �F�'r�j`�.y„�. ��� �..f R. •�5 � ��+�1 �'I , `,` ',` t` ,y�. ..•�. - �'� ��k.'r. i<,(IF,. 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Main Rd. &Youngs Ave.) Southold,NY 11971 • Q Telephone: 631765-1938 ®lyc®U ,� 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 ROBERT SERLING SCTM# 1000-86-2-10 ROBERT SERLING requests an Administrative Permit to construct a 25'x25' picnic area using 2" RCA base, top dressed with 3/8" natural stone, with 4" metal edge to frame and nine (9) flat topped boulders for sitting; 6'x6' on-grade bluestone patio with stepping stones for entranceway; construct 2 or 3 courses of 4"x4" cedar secured by rebar at seaward end of picnic area. Located: 3575 Wells Road, Peconic. SCTM#: 1000-86-2-10 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 O�� (/Tyol Michael J.Domino,President DF SOTown Hall Annex John M.Bredemeyer III,Vice-President O 54375 Route 25 P.O.Box 1179 Glenn GoldsmithCA Southold,New York 11971 A. Nicholas Krupski ® COQ Telephone (631) 765-1892 Greg Williams O1�COWN Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application APR L 9 2019 --7—Administrative Permit Amendment/Transfer/Exten�s}'o-n _ {�R�eceived Application: T 24.1q v Received Fee: $ 100.00 Completed Application: •34• Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): b•1•Iq �LWRP Consistency Assessment Form Sent: —- — CAC Referral Sent: Date of Inspection: •I2.1 Receipt of CAC Report: I Technical Review: I Public Hearing Held: Resolution: I 1 II Owner(s) Legal Name of Property (as shown on Deed): E0 8 e 2 T- <SEeL Al Mailing Address: dip 5-702 LZ� Phone Number: c �G6 7 q,5 9 2- (6'e Suffolk County Tax Map Number: 1000 - S 6 --Z - / PropertyLocation: 3,!5Z1S u"xeL L S 126 it� PECO n/-C_ 9 5 a L5 �/ 26!.e( joa�`'� d ��`/ A)Q C� (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Board of Trustees Appli tion GENERAL DATA Land Area(in square feet): 1(,, �// cS�rc- Area Zoning: - 7 Previous use of property: �Si Intended use of property: e.s CA�ei.7 c-_e — J ,o !�!`e 'Zc2. < VV 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-_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 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 —No Does the structure (s) on property have a valid Certificate of Occupancy?—Yes No Prior permits/approvals for site improvements: g A ency ate / `2—& 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): 3fO ViL A� 1 4�& _ a, n, s4v k) z- 73 o u-Ut r--r A,--- S., P�-,� Aro i�� ivy c���- (�( (J,L sfis — vs c (( (moi v -�0 r y 6 ' 7amti o C- tidy 5- ppr 0"5 S-tvAes -C-0✓ LOL-yG.k c.e- . Board of Trustees Appli :ion WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: e Y' r� 42 Area of wetlands on lot: square feet Percent coverage of lot: % l / Closest distance between nearest existing structure and upland edge of wetlands: (0 —ld feet Closest distance between nearest proposed structure and upland edge of wetlands: S6 feet Does the project involve excavation or filling? No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations (use attachments if appropriate): '410n 61 Z20 Appendix B Short Environmental Assessment Foy-in 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. Part 1 -Project and Sponsor Information Name of k6tian or Project: - `- -- - - - "- .ZcwL.r/L/ Project Location(describe,and attach a location map): Brief Description of Proposed Action: X- Name of Applicant or Sponsor: Telephon�L�/6 (` /� . ^ _ '53 -mss- z eo eew'r- (J Z!5 4�"/V E-Mail s�+P %`%� �¢ c O 01 Address: City/PO: State- Zip Code: 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 r ❑ may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action regdire a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: F\7 ❑ 3.a.Total acreage of the site of the proposed action? acres b.Total acreage to be physically disturbed? 25-x(2 5e acs 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. .,,,_acres ❑Urban M Rural(non-agriculture) ❑Industrial ❑Commercial t2Residential(suburban) El Forest Agriculture El Aquatic ❑Other(specify): ❑Parkland Pagel of 4 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ lyr ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ 6. is the proposed action consistent with the predominant character of the existing built or natural O YES landscape? ❑ —Z 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: LZ I ❑ 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? N6 YES -If the proposed action will exceed requirements,describe design features and technologies: - - — - --- El 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: /ybic Ig!P ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: M El 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? E]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? ❑ —N 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 El Forest ❑Agricultural/grasslands ❑Early mid-successional MWetland ❑Urban Wuburban 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? N YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO A'S If Yes, A ❑ Ela.Will storm water discharges flow to adjacent properties? NO YES b.Will storm water discharges be directed to established conveyance systemsrunoff and toren drains)? If Yes,briefly describe: ]NO YES AIIA 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: ❑ INA 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 I AFFIRM THAT THE INFORMATION PROVI_DED_ABOVE IS_TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spo rname: F(D,5Ce7- c5e!E,P ;--IV ' 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 I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ 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? ❑ ❑ 4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El 1:1affect 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? 7. Will the proposed action impact existing: ❑ Ela.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? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ Llwaterbodies,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, 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) PRIM Page 4 of 4 Board of Trustees Appl'_ .',tion AFFIDAVIT BEING DULY SWORN DEPOS S ND AFFIRMS—_TJWAT HE/SHE IS TPE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE-TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED'BYITHE SOUTHOLD TOWN BOARD OF TRUSTEES. THE-APPLICANT AGREES TO HOLD THE-TOWN OF SOUTHOLD AND'THE —J-- --- --- 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 MYPROPERTY 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. A � i nature of Pr rt Owner Si tore of Pr wrier SWORN TO BEFORE ME THIS �� DAY OF , 2019 Notary Public ,� �� 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: 7 (Las ame,first name, ddle initial,TIe s you are applying in the name of someone else or other entity,such as a c pany.If so,indicate the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) -Tax grievance — -- -- --- - Building Variance Trustee Change of Zone Coastal Erosion Approval of plat I Mooring Exemption from plat or official map Planning 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 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 0P day of�Ajoy^j 200 �( Signature e Print Nam Form TS I 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 Jachievement of the LWRP policy standards and condi4ons contained in the consistency review law. Thus, each answer must be explained in detail, listing both supportintz and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# - C7Z - / 0 PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees XT 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: l IFF —A 26f Location of action: ,,� S 1��;t5z G� Site acreage: ` Present land use: 657Z,�,e5 Present zoning classification: �� Zelo 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: (b) Mailing address: �j 7, 100GAal 57 (c) Telephone number: Area Code J53 (d) Application number,if any: 1A Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes 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 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 0 No x Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria ❑ Yes ❑ No K 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 ❑ 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 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. /a Yes ❑ No [:] Not Applicable - --- — - C &1*�1111 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 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. nn ❑ YesEl NoNot Applicable /'e® "aA el /` �0 le'le Attach additional sheets if necessary WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent rases in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No VNo-t 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 ❑ Not Applicable ` _6 61 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 I Not Applicable 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. Xyes ❑ No ❑ Not Applicable G .e tc-2 e� // PREPARED BY ?0,6,(_2(/" I TITLE DATE