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HomeMy WebLinkAboutTR-9536A ���Suf FO14 Michael J. Domino, President c�o� o� Town Hall Annex John M. Bredemeyer, III, Vice-President ;°= y1 54375 Route 25 Glenn Goldsmith r N z P.O. Box 1179 A Nicholas Krupski3 y ,r Southold, NY 11971 Greg Williams �01 , „ ���r 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 '/2 constructed When project complete, call for compliance inspection; Michael J.Domino,President *QF SU(/rTown Hall Annex John M.Bredemeyer III,Vice-President hQ� ��� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith J [ Southold,New York 11971 A.Nicholas Krupski G h Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 1 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9536A Date of Receipt of Application: July 24, 2019 Applicant: Suzanne Fraser SCTM#: 1000-90-3-6 Project Location: 800 Lakeside Drive, Southold Date of Resolution/Issuance: September 18, 2019 Date of Expiration: September 18, 2021 Reviewed by: Greg Williams, Trustee Project Description: Construct a 4'x8' timber kayak rack. 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 site plan prepared by Jeffrey Patanjo, dated June 24, 2019 and stamped approved on September 18, 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 'i i 91/R VE Y OF n r I IN E II i I ! l�✓fir, OF CEDAR BEA; SI TUA I E L J U L 2 4 2019 SOU T i--;OLD (EA YV7EW), ' TOWN OF SOUTL'-OLD L Southold Town -SUFFOLK.�UFFOL)'C CvUN T l-, IV. f Boar o rustees LAKESIDE n I / �/�� V E N(�R �� SURVEYED FOR JOSEPH COMO LIL — — _ WATER L1Ali'— _�PROX. LOCATION�— 5 60` 20' 30" E LIL J7 - - FD T 189.91 ' FD aw lSURVEYED 08 JANUARY, 2001 o p� SCALE 1"=30" Qs 0 0 �s' N AREA= 29,334.934 SF LOT 57 27 S' 432' v 31.3' OR _ 36. 0.673 ACRES Io. FOUNDA 77ON LOCA 77ON PROPOSED 18x36IN-GROUND m (EXTERIOR ONL Y) 3.0' POOL ZONED R40 0 ELEVA T70NS TAKEN FROM r, EAST END TOPO MAPS r3 s' HA YBALILINE Lor 5 { GUARANTEES INDICATED HERE ON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY �/STU /L T IS PREPARED, AND ON HIS BEHALF TO THE BA � FF 7777 E COMPANY, GOVERNMENTAL AGENCY, \ / c) LENDING INSTTUTON, 1F LISTED HEREON, AND 7-0 THE ASS ZONE /� / ^ O GUARANTEESGNEES ARE NOT TRANSFERABLE TO DON l V ADDIT70NAL INS77TU77ONS OR SUBSEQUENT OWNERS. UNAU7HORIZED ALTERA77ON OR ADD177ON TO THIS SURVEY IS A VIOLA TON OF SECTON 7209 OF L 0 T 59 N THE NEW YORK STATE EDUCA77ON LAW /6 g�3 '�' N 56. 3a' 11 ;�F-moi 4�= 0• LOT 59 FD l 32 01 17 W N 55 24, 27" 2 17" THE LANDES SURVEYORS THIS SURVEY MAP NOT BEARING SURVEYORS EMBOSSED SEAL SHALL FD / 47 80 36.1$ - NOT BE CONSIDERED TO 8E A VALID TRUE 4 CA! COPY. ! 3/ 4 228.20' FLOOD ZONE LINE FROM N,8� 3} / MAP NO. H. l7E LINE •� 1N1S DAA 3E MA?a 19 8 9 N 66` 17' S4" -W. RwA TEF LAND) 50 Cy FILL TO BE USED EFFEC EDA1 H�LD 10.39' OF NON—WETLAND AREA TOWN OF SOU T COVERED BY 5 T & DW SURVEYED BY ! F F EL. T i. z,' FM #90 STANLEY J. I AKSEN, JR. FILED DECEMBER 20, 1927 I� ORIG SURFACE GRADE EL. 10 P.0. BOX TM 1000-090-03-006 NEN SUFFOLK, NY 11955 NOTE. LANDWARD LIMITS OF TIDAL WETLANDS INV. EL. 7.8 INV. EL. 75 516 7J4 S 'S AS DELINA TED ON APRIL 8, 2001 BY INV EL i 8.5 C.W. BOWMAN / LAND USE ECOLOGICAL SERVICES, INC. GUARANTEED To I INV. EL. 8.3 � EL_ 3.8 LICENS D LAND SUP E OR JOSEPH COMO 3' MIN. NYS C. N0. ?927 I SEP T1 C TANK -GROUND WA TER EL. 0.8 2. SHOW POURED CONC. FOUNDA 77ON AND PROPOSED IN—GROUND POC;L. 19 AUG 03 1 RELOCATE HAYBALE LINE TO 1' LANDWARD OF 50' NON-DISTURBANrE BUFFER LINE 28 1UL03 N T.S CESSPOOL 03C1235 Marin-e-EnvironMentl COO 5,ech Rd reserve ; 'AV�' LADE SIDE DRIVE NORTH I Cedar Beach Counl S 60020 Rd '30" E 189.91 ARd Cedar I Beach Poi 800,Lbkes1de Drive North., APPROVED BY 'BOARD OF I RUSTEES 00 -TOWN,OF SOUTHOLD DATE seprow&A 2oq 777/— LOCATION MAP N.T.S. 2 STORY FRAME RESIDENCE KAYAK ON SIDE (TYP — 4) 3"x6* TIMBER CROSS BRACES "X6" TIMBER POSTS 48 3"x6" TIMBER CROSS BRACES OUTLINE OF EXISTING WOODED AREA /j3' EXISTING DEER FENCE TO REMAIN EXISTING GATE C, 30" PROPOSED KAYACK RACK TO CONSIST OF 6"X6" VERTICAL POSTS WITH 3"X6" HORIZONTAL CROSS BRACES (2 LEVELS) TO SUPPORT KAYACKS A MINIMUM OF 30" OFF THE EXISTING GROUND AT ALL TIMES OVERALL DIMENSION TO BE 4' WIDE X 8' LONG KAYAK RACK DETAIL Cq 1\1 T Q 93.69 56034"If" )r N 51o46'30" W N 60oO6'f7" 0' 113 —...n C E '9 V 794, — — Ar 55o24'27" D M.H 32.21' 77 — .05 47.80 FRF ... JUL 2 4 2019 0311 Emardl-if Trusts- Proposed Permit Plans SCALE: NOTES: CREEK PROPOSED PLAN, DETAIL AND DATE: PROPERTY OWNER: PREPARED BY: LOCATION MAP 6-24-19 PROPOSED P 0 P 1. LOT AREA: 29,334.934 S.F. 0.673 ACRES SUZANNE FRASER JEFFREY PATANJO B BO'O LAKESIDE DRIVE NORTH 2. PORTIONS OF PLAN FROM SURVEY PREPARED BY: 13565 MAIN BAYVIEW ROAD P.O. BOX 582 0 STANLEY J. ISAKEN JR. bUUIHULU, NY 11971 BOHEMIA, NY 11716 SOUTHOLD, TOWN OF SOUTHOLD P.O. BOX 294 NEW SUFFOLK NY, 11956 631-484-9332 x m SUFFOLK COUNTY, NY SHEET: SURVEY LATEST DATED JANUARY 8, 2001 JJPATANJO@GMAIL.COM Proposed MAP NO. 1000-090-03-006 1 OF 1 - I Michael J. Domino, Presid �Q CC ! Towp Hall Annex John M. B,Iredemeyer III, Vice-Presment ��� Gym - 54375 Route 25 Glenn Goldsmith y P.O.Box 1179 Me A.Nicholas Krupski r Southold,NY 11971 Greg Williams ?' p! Telephone(631)765-1892 X01 Fax(631)765-6641 BOARD OF TOWN TRUSTEES Q� TOWN OF SOUTHOLD Date/Time- Completed in field by: Jeffrey Patanjo on behalf of SUZANNE FRASER requests an Administrative Permit to construct a 4'x8' timber kayak rack. Located: 800 Lakeside Drive, Southold. SCTM#i 1000-90-3-6 I I 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 I 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 I Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Ui Misted Action Type of Application: Pre-Submission Administrative i Amendment Wetland Coastal Erosion Emergency ViI lation 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: 5e9_0 'S"r O Ao, vIc' Ds t 1-5,; Q z�- 9 ,roA�' I I i I I I have read & acknowledged the foregoing Trustees comments. ! Agent/Owner: I I Present were: J. Bredemeyer M. Domino G. I Goldsmith N. Krupski ! G. Williams Other I �,�.: '�, ,. ���, � r��� �� �:. �� r ��:� ; . :... ,. .. .�., �� i e, � h 4 .L '7r � • mitis 'r. ��.IF i t � , w - r i t • yam'. __ V � rr► � r+ 16 AF If 6 4 IoNN OF ^ ^ i souTltDtn a o as 0 �•.m.T 13 f6 14 5Nc) • 6�r e �R CEOgR ' ryri nn nn ('OIIvT iPKEi\oEp 1 2 w n OR 4 ro u ' M7at m u( S 6 "II_______ SalnNolD ,3 OO CEDAR Q9 t u^ $ T01vN wSt%1 H= n„, POfNT "4 20A(c) 6 13 2, as 6 —n `• 15 nq WEST F LAKE a n, ? p m �qrq o +B t p at t.eN O� s1.9.0 (50') • ,m W KE f m `m + I X1 t v yt � 15 p 21 n Z ' J �1)A(<) IB 1) 16 i 19 5 19 10 6 HOG NEC/ BAY �8 a NOTICE COUNTY OF SUFFOLK © E °°° °` S�NaO SECTION NO ` 09 E ,,,,,,m,„m„,� �,) ew RealPropeRyTaxServiceAgency v � s r„a Q v. c„nnr c.nr.aw,nw.xr nwt M o90 „.m, .w„rewxe.rrvu„w ute ca avr,n wmwn ar,„e g m cwro,„ca„.....w an,awx„n ...._.t_� �.. �,",. ...��•• �: wn.ovrw„nn+nen.„wox o,r„e ?: �m oxo �r.m m P T- 10.0 [xsmh: PNOPERTY NAA OFFICE LOCATION: ®� S®Ury®l 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: 631765-1938 ®I�cOUNTY,� 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: September 16, 2019 Re: LWRP Coastal Consistency Review for SUZANNE FRASER SCTM# 1000-90-3-6 Jeffrey Patanjo on behalf of SUZANNE FRASER requests an Administrative Permit to construct a 4'x8' timber kayak rack. Located: 800 Lakeside Drive, Southold. SCTM#: 1000-90-3-6 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, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore 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 Michael J.Domino,-President of S®UT/fiO Town Hall Annex John M.Bredemeyer III,Vice-President �O l® ` 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G ® o Telephone (631) 765-1892 Greg Williams �D� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application D E (ra 2 � �1 V// E Wetland Permit Application uV IS Administrative Permit Amendment/Transfer/Extenon71erq JUL 2 4 2019 Received Application: Received Fee: $ 1®Q, -Completed Application: a Southold ToUm Incomplete: _ _-_ r of TrustPo SEQRA Classification: Type I Type II Unlisted f ive Dec. Lead Agency Determination Date: ow —� Coordination:(date sent): 0/ LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: •�j Receipt of CAC Report: Technical Review: ublic Hearing Held: Resolution: Owner(s) Legal Name of Property (as shown on Deed): 5 v eon ne- Fr k 5e!' Mailing Address: :'So -Po,tr1L eve -* 1014-A )4®boy-evt_, tjS 0-1-o"30 - Phone Number: 917- 5101 -45a�o Suffolk County Tax Map Number: 1000 - 9 D - Property Location: $off `xize-srzec o-4ti of A nJ 1 11-17/ stc I ve A-o v^ Irl to (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): -FFre Mailing Address: Phone Number: �'vl• `r �`� ' q 3 3�' Board of Trustees App} ^ation GENERAL DATA Land Area(in square feet): a Area Zoning: fLes. Previous use of property: f2,e-S . Intended use of property: r 214-S 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 ✓ 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: Agency Date v"'-�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): CAs Sf'eme f q it ' -fr M &e/L Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Don s?'rv-c--t bio+ t t.L- KA y,&IL 2o4 CX . Area of wetlands on lot: 2 0 o square feet Percent coverage of lot: B % Closest distance between nearest existing structure and upland edge of wetlands: /d feet Closest distance between nearest proposed structure and upland edge of wetlands: /D feet Does the project involve excavation or filling? ✓ No Yes If yes, how much material will be excavated? N cubic yards How much material will be filled? N cubic yards Depth of which material will be removed or deposited: 1v 1,4 feet Proposed slope throughout the area of operations: A 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): Them will he- Q.s.t,;vc a r.(ee4 cQ(,c fa ,,,v copy« Board of Trustees Applj,,_. tion AFFIDAVIT 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/IIER 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. Signa®r of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS to DAY OF U L-7 , 20 tary Public RITU MAKIN Notary Public—State of New Jersey My Commission Expires Jan 25,2022 Board of Trustees Applj' tion AUTHORIZATION (Where the applicant is not the owner) I/We, s V Qr.%n a e- *::-ra s e/-- owners of the property identified as SCTM# 1000- '70 - 3 -lo in the town of S New York,hereby authorizes P4+4 n 1 a to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Properlo wner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF V ,20 I -41�oitary Public [�q�Lary =Stateof ersey,2022 AyyLIGATQa1AC-s,EI�")i/REYRF,SE'i`i'i'tsi,'TiY� TRAr-TSACTIONAL DISCLOSURE FORM _The Town of Southold's Code of Ethics prohibits conflicts of interest on the pari 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: T_'7r't SeR-. v 2 a n st e (Last name,first name,griddle 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 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%ares. 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 this day of 20 Signature Print Name Form TS I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIOINAL DISCLOSIURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the hart of town officers and employees.The purpose of this form is torovide information which can alert the town of possible conflicts of interest and allow it to tale whatever action is necessary to avoid same. YOURNAME: (Last name,first nafne,iii dle initial,unless fou 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 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 a 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 this 2 It day of Sv At— 20 �9 Signature — Print Name :f44k r..,- ft 4-4!*D Form TS 1 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 infor}nation 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: 800 Lakeside Drive N.-Southold Kayak Rack Project Location(describe,and attach a location map): See Ipcation map Brigf Description of Proposed Action: Install kayak rack in location shown on plans in existing clearing area. Name of Applicant or Sponsor: Telephone:P 917-519-8260susfraser@aol.com Suzanne Fraser E-Mail: Address: 130 Park Ave.#PH-A City/PO: State: Zip Code: Hoboken NJ 07030 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 El 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 government Agency? NO YES If Yes,list agency(s)name and permit or approval:Town of Southold Trustees/NYSDEC ❑ 3. a.Total acreage of the site of the proposed action? 0.673 acres b.Total acreage to be physically disturbed? o acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 0.673 acres 4. Check all land uses that occur on,are adjoining or near the proposed action: 5. ❑Urban ❑ Rural(non-agriculture) ❑ Industrial ❑ Commercial 0 Residential(suburban) ❑Forest ❑ Agriculture ❑ Aquatic ❑ Other(Specify): ❑Parkland Paoc 1 of 3 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ Fv� ❑ b. Consistent with the adopted comprehensive plan? ❑ F&/] ❑ NO YES 6. Is the proposed action consistent with the predominant character of the existing built or natural landscape? El Fv_1 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES Name-Cedar Beach,Name:Pecornc Bay and Environs,Reason:Significant coastal fish&wildlife habitat, If Yes,identify: Reason:Protect public health,water,vegetation,&scenic beauty,Agency:Southoid,Town of,Agency:Suffolk County,D.. ❑ NO YES 8. a. Will the proposed action result in a substantial increase in traffic above present levels? ❑ ❑ b. Are public transportation services available at or near the site of the proposed action? ❑ c. Are any pedestrian accommodations or bicycle routes available on or near the 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: El FV1 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 project site contain,or is it substantially contiguous to,a building,archaeological site,or district NO YES which is listed on the National or State Register of Historic Places,or that has been determined by the ❑ Coipmissioner of the NYS Office of Parks,Recreation and Historic Preservation to be eligible for listing on the RI State Register of Historic Places? b.Is the project site,or any portion of it,located in or adjacent to an area designated as sensitive for ❑ archaeological sites on the NY State Historic Preservation Office(SHPO)archaeological site inventory? 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: Page 2 of 3 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 by the State or NO YES Federal government as threatened or endangered? Least Tern,Piping Plover,... ❑ 21 16. Is the project site located in the 100-year flood plan? NO YES 1:1 Rl- 17. Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑I E]— a. a. Will storm water discharges flow to adjacent properties? RI ❑ b. Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? Z ❑ If Yes,briefly describe: 18. Does the proposed action include construction or other activities that would result in the impoundment of water NO YES or other liquids(e.g.,retention pond,waste lagoon,dam)? If Yes, explain the purpose and size of the impoundment: ❑ ❑ 19. Has the site of the proposed action or an adjoining property been the location of an active or closed solid waste NO YES 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 CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor/name: Suzanne Fraser Date: -7 11 Signature: r' Title:Owner PRINT FORM P i(,c 3 of 3 EAF Mapper Sumi ry Report Tuesday, June 18, 2019 10:06 PM Disclaimer: The EAF Mapper Is a screening tool Intended to assist I 5000-400 8'003` 9000,;-300=1 400 6. I protect sponsors and reviewing agencies In preparing an environmental 1 `1P>,, V' o000-400-18000 assessment form(EAF) Not all questions asked in the EAF are 9000-400-2000 { ti i-%<°000-400-7 000' I answered by the EAF Mapper.Additional Information on any EAF tiP` " `•,90 00--30 0-1 30 40', I question can be obtained by consulting the EAF Workbooks Although 9000--300-3000.=, \� 90'00-400-2 1000''I —� the EAF Mapper provides the most up-to-date digital data available to DEC,you may also need to contact local or other data sources in order l 4 9300-200-2002 to obtain data not provided by the Mapper Digital data Is not a 9000--100-2200j0,000-300-17000`-�, substitute for agency determinations. 9000--300--3000 I� - • o000-300-3060 j' ' - t7ttara anh'ool f" - P`-- L1 3Q00-300-2000 ~ '`o_ = '9000-440-6001 1�70�d '' '� c i •I lr rr' 9000-300-4060 1l O1 9000-300-500 •g0004300-6000 �1 Toronto 9300-200-2002 PA, NiiRan �1'cchp ler 9000-300-7000 Y_Z-'—'- ---__ ��_ �l 9000--300-5001 I Dctrolt _ n Ba:tcn Prodclence 9000-°10C5gLy(*.) E1ri,.-HEPE,Germin,USGS• , ' Clevel.lcl S c IntermeF, ItJ6P.Ef:QEPiT i7,fdRCa�rEs'ri o "`~ y t X000-3 00-1 2 000 .< - r', uu. I sI IGc ryryv.y o Japsri,METI,EsriCt ina-,Heng I cng),-Esri" urc�s,Esri,i� E,Garmin, 000-300-11000 , :�Pit�bargh =Kcres,Esri(Thailand).NC-C ., INCREMENT 9000-300-10000 �tiy ) = Is Columbus uSGF"otllntt=5rt,p OF�nSfr�tlj7aP gtributcrs+and the GIS F•NRCsn,EsriJapan,klETI. r'r UVU- VL" ruvu; ,f 9000-300-18001 cinnnti -A � 000 G0-1 2C�J ommLnrl !I 1VaE s.s.j( �Ilns,Hcng iCcng),Esri Part 1 /Question 7 [Critical Environmental Yes Area] Part 1 /Question 7 [Critical`Environmental Name:Cedar Beach, Name:Peconic Bay and Environs, Reason:Significant Area- Identify] coastal fish &wildlife habitat, Reason:Protect public health,water, vegetation, &scenic beauty,Agency:Southold, Town of,Agency:Suffolk County, Date:3-9- 90, Date:7-12-88 Part 1 /Question 12a [National or State No Register of Historic Places or State Eligible Sites] Part 1 /Question 12b [Archeological Sites] Yes Part 1 /Question 13a [Wetlands or Other Yes-Digital mapping information on local and federal wetlands and Regulated Waterbodies] waterbodies is known to be incomplete. Refer to EAF Workbook. Part 1 /Question 15[Threatened or Yes Endangered Animal] Part 1 /Question 15 [Threatened or Least Tern, Piping Plover, Common Tern Endangered Animal- Name] Part 1 /Question 16[100 Year Flood Plain] Yes Part 1 /Question 20 [Remediation Site] No Short Environmental Assessment Form - EAF Mapper Summary Report 1 Part 2-Impact A.sse-----nt. The Lead Agency is responsible for the coi ;ion of Part 2. Answer all of the following questions in Part 2 usi a information contained in Part I and other mater ubmitted by the project sponsor or otherwise available to,»„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 Rloderat t small to large t impact impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning 1:1 ❑ regulations? 1 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 ❑ F]i establishment of Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El ❑ 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 El _ ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ ❑ 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? 9_ Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, I� ❑ waterbodies,groundwater,air quality,flora and fauna)? {—Wj 10 Will the proposed action result in an increase in the potential for erosion;flooding or drainage ❑ ❑ problems? ll. 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(his 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 iequired. ❑ 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 i 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) 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 siowcant 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 M. lained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website(southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 9 0 - 3 - 4 PROJECT NAME 9'o a L u aS&Xe- 04, �J The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LJ 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: `-� p Location of action: S o A 1 -40 5 i PC p 2- .� - S o✓-} Ao f� Site acreage: 0. 6 -73 Present land use: J2.e,S - Present zoning classification: (LO-S . 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: S v-2::-a n n G N S e2 (b) Mailing address: 13'�_ _i� 21L v e -?14-,Dr �b014e/l � (c) Telephone number: Area Code( ) 01/7 (d) Application number,if any: / t/ P' Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes RrNo❑ If yes,which state or federal agency? k-x(S b Ce-- C. <LCo 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 wi9l require that the form be returned for completion. D + +LOPEIID 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 LIAW Section In-Policies; Page 2 for evaluation criteria. mYes ❑ No ❑ loot Applicable Prod-IC4 4 "Se Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological mources of the Town of Southold. See LWRP Section III-Polici s Pages 3 through 6 forevaluation criteria 1:1Yes 1:1No Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LW"Section 1111-Policies Pages 6 through J for evaluation criteria ❑ Yes ❑ No �I�ot Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LVMIP Section 11II-Policies Pages S through 16 for evaluation criteria F] Yes ❑ leo loot Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See E Sections IIn -Policies Pages 16 through 21 for evaluation criteria Yes ❑ No ❑loot Applicable r--jer-+ Prvt«-t-s de.Cf-,etionj ef-e titin sn6o .fie GVtJ1 LtI.vNL� A 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 II1111-Folicies; Pages 22 through 32 for evaluation criteria. Yes leo t Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRF Section III — Policies Mages 32 through 34 for evaluation criteria. ❑ Yes ❑ No�Ie1ot Applicable 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. 1:1 Yes ❑ leo l-J 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 LVW Sections III—Policies,- Pages 38 through 46 for evaluation criteria. YeO No❑ Not Applicable U OF ®iO SOX 7t:6 ��'�fa K— n N q 1-4 Attach additional sheets if necessary WORDING COAST P ICIES ` Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See EIRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No I�Tot 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 Attach additional sheets if necessary Policy 12. Protect agricultural lands in the 'Town of Southold. See L'WRP Section III—Policies; Pages 62 through 65 for eval ation criteria. ❑ Yes El No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVVRP Section III—Policies; P ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED ]BY i.c �-a��o TITLE i4 yr�l� DATE 9-2Y-11 July 17, 2019 Town of Southold Trustees -� Town Hall Annex Building 1E C � ! � 54375 Rte. 25 P.O. Box 1179 JUL 2 4 2019 Southold, New York 11971 RE: 800 LAKESIDE DR. N. -SOUTHOLD SoutWd Town SCTIVI No. 1000-90-3-6 a o Tr ee APPLICATION FOR PERMIT Dear Trustees: We hereby submit one (1) original and three (3) copies of the proposed plans, application and check for permit approval for the above referenced project. If you should have any questions or require anything further, please do not hesitate to call me at 631-484-9332. Very truly yours, J rey Patanjo P.O. Box 582 Bohemia, NY 11716