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HomeMy WebLinkAboutTR-9574A �. Michael J. Domino, President `opo to ` Town Hall Annex John M. Bredemeyer, III, Vice-President 'o 1 54375 Route 25 Glenn Goldsmith N ,? P_O. Box 1179 A Nicholas Krupski y ;' Southold, NY 11971 Greg Williams , ��s 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 A0 so�Ty Town Hall Annex � John M.Bredemeyer III,Vice-President �� l0 54375 Route 25P.O.Box 1179 Glenn Goldsmith [ Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams �O �� Fax(631) 765-6641 I�COU0 5 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9574A Date of Receipt of Application: September 6, 2019 Applicant: Philip Loria SCTM#: 1000-117-7-31 Project Location: 1090 First Street, New Suffolk Date of Resolution/Issuance: November 13, 2019 Date of Expiration: November 13, 2021 Reviewed by: Board of Trustees Project Description: As-built re-sheathing of 105' of timber bulkhead with vinyl with an 8' return on the southeast corner; replace dead-men and all hardware with hot dipped galvanized hardware; bulkhead to be capped with 2" CCA wood. Backfill with 60 yards of clean sand from an approved source. All work to be done on the landward side of the bulkhead. 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 survey prepared by Contractors' Line & Grade South LLC, last dated October 25, 2019 and stamped approved on November 13, 2019; and the project plan prepared by Philip Loria, received on September 6, 2019 and stamped approved on November 13, 2019. Special"Conditions: To establish and perpetually maintain a 10' wide non-turf buffer landward of the bulkhead. The Permittee is required to provide evidence that a copy of this Trustee permit has been recorded with the Suffolk County Clerk's Office as a notice covenant and deed restriction to the deed of the subject parcel. Such evidence shall be provided within ninety (90) calendar days of issuance of this permit. 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 APP s 01-11"_ .. B SEP 6 2019 BOARD GF : J--,,'k)STEEa wC'A C; I_1.f..;,x"11E) JrU�tlr7,d Terrll TOWN OF 5C)" �,Lpp - - L'OCf �)i IYT rlls"P^S ®ATE Novi P,�i2 l3 2019 ,2, lGd,0 l � Hw iz Zo fr �X►sTiat)G G=�'��� S V6U Jl � �`fi�b x fS Ti�G Pe kF r h1 e,w S r—l—ldf l/,. P E C 0 N I C B A Y APPROVED BY BW 0.8' BW 1.0' TW 4.0' TW 3.8' BW 25' , BW 26' BOARD OF -i RUSTEES S36'34'49'W S01'37WOOD'32'E TW 5B1.4! I CONC TOWN OF SOUTHOLD 3.30 (SURVEY) BULKHEAD WAS S02'32 46'W 81.19' (SURVEY) BW 4 ---------------- 2.52' (SURVEY) SO4'09'00'E _ BW_0.S- - - TW DATE 14.79' (SURVEY) _�0.21- - -- _ I ew 2.T /VO WOOD � BW 3.9' V bo 13 &l q BULKHEADTN 5.9' BW 48' SIdN T [4 7] TW s.7 - SHED x - - - - - � - .1w 5.9' PIN�°'� - _ REMAINS 1 W 5.9' BW 3.0 . 9 METAL BW 3:D' FLOOD ZONE VE SHEETING a' L'' (ELEV. B) -o [GRASS] Certified, as noted and limited below, only to: =o R FL00p ZONE UNE C\2 - PHIL LORIACeD o [6.1] w C� [5 4] ° _ ] O SUBJECT PREMISES AREA = 6,962 SQ. FT. (0.159 Ac.) E-1 I I [5.7] o lat [4 7 a � � � LOT 31 � � a o� N�� THE PREMISES HEREON BEING KNOWN AS LOT 31, BLOCK 7,SECTION 117, 1J 3 (6.0] tL y DISTRICT 1000 AS SHOWN ON THE OFFICIAL TAX MAPS OF THE COUNTY "A" 9� -[BOAT YARD] j �P J bye ��� CO OF SUFFOLK L_ T JBER at En o o [4.6] 1 FLOOD ZONE AE o �� << THE SURVEYOR'S SEAL, SIGNATURE AND ANY CERTIFICATION APPEARING C AueE1 JN o [6.2] [GRASS]CA (� 6) HEREON SIGNIFY 1HAT, TO THE BEST OF HIS KNOWLEDGE AND BELIEF, 2 STORY 7 THIS SURVEY WAS PREPARED IN ACCORDANCE WITH THE MINIMUM N FRAME I 3 0' [5.7] a STANDARDS FOR LAND SURVEYS AS SET FORTH IN THE CODE OF L"""' " 3 x [X] [ ] [ ] t� 050pS" PRACTICE ADOPTED BY THE NEW YORK STATE ASSOCIATION OF 3 I 100 37' TO THE TO THE Q S PROFESSIONAL LAND SURVEYORS, INC. o l._ 100.33' NO6'59'10'E , NORTHERN SIDE OF KING STREET LAND CERTIFICATIONS SHALL RUN ONLY TO THE PERSON FOR WHOM THIS [WOOD WALL] [MONUMENT FOUND] [4'7] D CH LS SURVEY WAS PREPARED, AND ON HIS BEHALF, TO THE TITLE COMPANY, [GRAVEL] [4.41 [4.3] LENDING INSTITUTION AND GOVERNMENTAL AGENCY LISTED HEREON; SAID _ _ - - - - - - _ _ [4.1] CERTIFICATIONS ARE NOT INTENDED TO RUN TO ADDITIONAL TITLE 1 - - - - - - - -0 - - - -; OCT 3 02019 COMPANIES, LENDING INSTITUTIONS, SUBSEQUENT OWNERS OR FUTURE [4.6] [4.4] �N m CONTRACT ODES. (4.9] F I R S T [5.1] S T R E E T 64[4 8] ELEVATIONS HEREON WERE TAKEN FROM AN ACTUAL FIELD SURVEY BY [a.s] X x x x [�J Southold TownTHIS OFFICE ON OCTOBER 24, 2017 ALL ELEVATIONS ARE RELATIVE TO [5.1] [MACADAM ROADWAY] Bar of Trustee [4.8] NAVD-88 DATUM. - - - - - - - - [5.0] [4.9] [5.0] [4.7] i- A PORTION OF THE PREMISES HEREON LIES WITHIN AN AREA OF SPECIAL PROPERTY SURVEY FLOOD HAllARD (ZONE AE) (M. 6) & (ZONE VE)(ELEV. 8) AS 5 4 DEPICTED ON FLOOD INSURANCE RATE MAP No 36103CO501H, REVISED PREPARED FOR Q SEPTEMBER 25, 2009. PHIL L ORIA w � w z o UNDERGROUND IMPROVEMENTS, STRUCTURES, UTILITIES OR ENCROACHMENTS, AND ANY EASEMENTS RELATED THERETO,ARE NOT PROPERTY S/TUA TE A T SHOWN HEREON UNLESS OTHERWISE NOTED. 8119 N83-41.50-W NO2'32'46•E s36.34491 1010 1090 FIRST STREET 2i2t3*43 S0137'3�E UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A 00 9� Np1���2TOWN OF SOUTLIHOLDLICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF SECTION 7209, S83'41'50'E E 9SUB-DIVISION 2 OF 1HE NEW YORK STATE EDUCATION LAW. 9951828COUNTY OF SUFFOLKCONTRACTORS' LINE & GRADE SOUTH L.L.C. 00 STATE OF NEW YORKN36Je49O 23 Nepperhan A venue 4.09 SCALE. 1" = 20' z Elmsford, New York 10523 Phone: (914) 347-3141 office0f neandgradanet SAM EASEAENT DETAIL Dote: OCTOBER 24, 2017 Copyright (c) 2017 CONTRACTORS'LINE & GRADE SOUTH All rights reserved. 0.\37-2381 Phil Loria f1RST ST\dwg\2381-Survey BASE2dwg ,S Michael J. Domient O SUFFQ� � Town Hall Annex John M. Bredemeyer II1 0— i Presdent 54375 Route 25 Glenn Goldsmithro a P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams 4,, oh- Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD / Date/Time: 1���°► 8 :3o Completed in field by: G �oUO- �� PHILIP LORIA requests an Administrative Permit for the as-built re-sheathing of 105' of timber bulkhead with vinyl with an 8' return on the southeast corner; replace dead-men and all hardware with hot dipped galvanized hardware; bulkhead to be capped with 2" CCA wood. Backfill with 60 yards of clean sand from an approved source. All work to be done on the landward side of the bulkhead. Located: 1090 First Street, New Suffolk. SCTM#: 1000-117-7-31 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 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <- 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: �`n hat9S.fl C•c��/i�w — Si'�ct,a�� �a�oal�ac-..� a la � Qon - EUrT 67MeC I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith " /N. Krupski 7- G. Williams Other IF- October 8, 2019 � E L_��� ;�, Arlene and Frank Castellano OCT 8 2019 1275 First Street,P.O. Box 304 New Suffolk,NY 11956 saothofd n,vn Board of';rus ees Southold Town Board of Trustees Southold Town Hall Annex 54375 Main Road P.O. Box 1179 Southold,NY 11971 Dear President Domino and Board Members: This letter is regarding Phil Loria's "as-built"Administrative Permit application for his property located at 1090 First Street,New Suffolk SCTM# 1000-117-7-31. I was surprised to see this application classified as an"Administrative Permit,"when all the neighboring bulkhead repairs on First Street required"Wetland Permits"from the Board of Trustees. It was my understanding that administrative permits were reserved for very minor projects.The work that was done at 1090 First Street,which took one month to complete,was not minor as it required excavation,truckloads of fill, installation of sheathing and pilings, removal of debris, and the alteration of the lot's elevation. Construction began on this property without a Trustee or DEC permit on August 12, 2019.A Code Enforcement complaint was submitted on August 13, 2019 and a police report was made via phone on August 22, 2019.A stop-work order was never issued and work continued. On September 6, 2019 Mr. Loria submitted an application for an"as-built"permit with the Board of Trustees. Construction was completed on September 11, 2019. In 2015, Mr. Loria rented his property to the owners of 1200 First Street for use as a construction site during the raising and rebuilding of their house. Mountains of contaminated excavated soil, debris, and garbage were dumped and stored for months on Mr. Loria's property.As far as I know, Mr. Loria did not obtain a permit from the Trustees to use his property for these purposes. Mr. Loria's property, which was once level with its neighbors was altered at this time to meet the height of the septic retaining wall which was installed on the property line. Because this project was completed without any inspection or permit from either the Board of Trustees or NYSDEC, it is difficult to know the extent of the work and the impact of the construction on the wetlands. Neither a silt fence nor a silt boom was used during construction and it is unclear what safety procedures were taken when excavating and removing debris from the site using heavy machinery. If anything, extra precautions should have been taken considering the contaminated soil and debris that was stored on this property. The amount of fill that was added to the site and its origin is also unknown. The elevation of the property has been V visibly changed once again with dirt/sand now reaching the top of the bulkhead where it hadn't before. In Mr. Loria's Trustee application,the names of the coastal contractors that proceeded with construction without a permit from the Trustees are not listed nor are the sources for the materials used. Mr. Loria indicates that his property does not contain any wetlands, is in a suburban habitat and not in the 100 year flood plain. He writes that no permit is required from other government agencies, when, as I understand it,bulkhead repairs require NYSDEC permits. Nearly all questions listed in the LWRP Consistency Assessment Form are checked, "Not Applicable." Both Mr. Loria and his neighbor, Mr. Wood, claim that a structure on their properties does not have a valid Certificate of Occupancy. The only structure on either of these lots is a dilapidated shed that sits between the two properties. This shed, which is completely falling apart, sits very close to the water. I do not know who the owns this structure, but if it does not have a valid C.O. it should be removed. I have been unable to locate an original Trustee Wetland permit for the bulkhead on this piece of property. I can only find a NYSDEC permit from 1975 and a storm repair permit from the Trustees dated 1993. I was hoping to understand why there is such a discrepancy between the measurements listed in the deed vs. the survey. The northern side of the property is listed as 51' in the deed and 63.4'in the survey and the southern side is listed as 71' in the deed and 76.98'in the survey. I do not have any issue with Mr. Loria making improvements or repairs to his property. I only wish that he would follow proper procedures and conduct the work in a legal manner, abiding by town code. Two years ago, he notified the Trustees of his intention to build a house on this lot. It seems obvious that Mr. Loria,who has owned waterfront property on First Street for 45 years, would be well aware that a Trustee permit would be required to do any work within the Trustee jurisdiction. With all of the concern for the water quality, health of the wetlands, and rising sea levels in Southold Town, it is disappointing to see work proceed without permits so blatantly. I would ask that the Board of Trustees reconsider this project's classification and, at the very least, ask that the applicant submit a thorough, detailed, and accurate application before any decision is made. I have enclosed eight photos. Sincer ly, Arlene Castellano, Frank Castellano U OCT 8 2019 Ssz';hri!d i(7m'ill Bcard of lri�si,:es _J R'M 7Y h` $T� IT w ii m ,r i yy v a r a 4 MwM " �' �;� � - illi► �?. - . - Lore A -PILI�(s5 ? +tlptl{. .i i r ' g r , " MYIIIY w v„ r� u Y- a or u„ + • > eF s s. r „ n Lo� �� 3 r' mom ' .._.� NEW t M i Grade before construction "eiA t+ —�`„ '�-----�•_� -�� +�Y.-- aft �p!ah, a _3 G � n „ p . 1- w ivx ,e ., .. 4- ..+mss �.�� $,i •_ -,:-. yW w r A' 'tea yet* .. iL•+M k�� � P.'JRve _ 'r m ....r ,fir. � �"+FdF. �t' ►-�"_ ,der. ^tri?' ��-�* •,> -, - I 't 00 70, 4 � > Grade after construction LoR�� S born x. i ! - { a4 ' i •fir - _. " �� �`' TY., 7 •. '04 - .y - ci ' .. .�.�t, _ .."•,., �` AIS � r �i . dr— . 0 90 T2s i S i• ('Lor,->.A-) 7 f; x ; SSV a :,f y 7 t� Yl �.N Michael J.-Domincf It �OSVFFQ�'�c0 i — Town Hall Annex O ;; John M. Bredemeyer III,Vice;.-.; ident 54375 Route 25 ' Glenn Goldsmith N a P.O.Box 1179 A.Nicholas Krupski !77 Southold,NY 11971 Greg Williams- .Telephone(631)765-1892 ' Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD 4Date/Time: o �Y Completed in field-by: J PHILIP LORIA requests an Administrative Permit for the as-built re-sheathing of 105'--of timber bulkhead with.vinyl with 'an 8' return on the southeast corner;-replace deadmen and all hardware with hot dipped galvanized hardware; bulkhead to be capped with 2" CCA wood. Backfill with 60 yards of clean sand from an approved source. All work to be done on the landward side of the bulkhead. Located: 1090 First Street, New Suffolk. SCTM#: 1000-117-7-31 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 SEQRA Type: 1 II Unlisted Action _ Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years-. Y/N Wetland Line by: C.E.H.A.- Line Additional information/suggested modifications/conditions/need for outside review/co nsultant/appIication completeness_/comments/standards: C-F P-( Jkf cd'g�OA ,1 0 y IU SiI 2 TLO� V'� 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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Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 �� Telephone: 631765-1938 ® Fax: 631 765-3136 COU05 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: October 10, 2019 Re: LWRP Coastal Consistency Review for PHILIP LORIA SCTM# 1000-117-7-31 PHILIP LORIA requests an Administrative Permit for the as-built re-sheathing of 105' of timber bulkhead with vinyl with an 8' return on the southeast corner; replace dead-men and all hardware with hot dipped galvanized hardware; bulkhead to be capped with 2" CCA wood. Backfill with 60 yards of clean sand from an approved source. All work to be done on the landward side of the bulkhead. Located: 1090 First Street, New Suffolk. SCTM#: 1000-117-7-31 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 provided the following is considered: Minimize the use of CCA treated materials (cap) in design to further Policy 6. 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 o��trzjF SOy®l Town Hall Annex John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski aQ Telephone (631) 765-1892 Greg Williams �COUNT`I, Fax(631) 765-6641 �� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only �`saelsnil,o aeon Coastal Erosion Permit Application ur.`,oa p_oUtnoS __ tland Permit Application _Administrative Permit Amendment/Transfer/Extensi ��i 6102 9 d�S Loi Received Application: `° 'Received Fee: $ ZOO.D /�5-Blll�-� Ij =411 =-;"1 iQ � -Completed Application: - __� Incomplete: SEQRA Classification: Type I Type 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): /®I�./� Fr— IF �LWRP Consistency Assessment Form Sent: CAC Referral Sent: SEP 6 2019 Date of Inspection: 10, { Receipt of CAC Report: Technical Review: ^� S,rd r) � 1,gr q _ Public Hearing Held: B�arci a;lr ir,cs _ 4 Resolution: Owner(s)Legal Name of Property (as shown on Deed): Mlle Mailing Address: Ve- uv e s 1k. en le4c� Phone Number: 40- '244 Suffolk County Tax Map Number: 1000 - I t 7 - 7 '3 Property Location: 10 9 u (If necessary, provide LILCO Pole#, distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: PROJECT DESCRIPTION (Attachment to Administrative Permit Application) ADDRESS: 1090 First Street, New Suffolk NY 11901 Owner: Philip Loria ,1;1S &M df- I would like to request an Administrat've Permit, 105 feet of existing interior timber Shoreguard Series 425 vinyl sheathing, 105 feet of said sheathing to be 10 feet in length,with 1 inch galvanized steel tie rods, and to include 8 feet return on the southeast corner/side; replace deadman and all hardware with hot dipped galvanized hardware. All work to be done on the landward side of bulkhead. Bulkhead to be capped with 2 inch CCA wood and back filled with 60 yards of clean sand from an approved source. Board of_.Trustpes Application GENERAL DATA Land Area(in square feet): Area Zoning: VA d AN-� L qVP- Previous use of property: V /+t yr Intended use of property: w e if, 1-i 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 t,�o Does the structure (s) on property have a valid Certificate of Occupancy? Yes XN o Prior permits/approvals for site improvements: Agency enc S 0 vt -� v�V ate r a 1q3 k, 4,t No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? e/ No Yes If yes,provide explanation: Project Description (use attachments if necessary):' Board of Trustees App�.Lcation WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: R - n i P- 14cA Area of wetlands on lot: J0 square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: © feet Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? No v1" Yes If yes, how much material will be excavated? Vo 1 cubic yards How much material will be filled? 4 b cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: ' /-,c O-ZJ Manner in which material will be removed or deposited: Ckewy 5.,4 LN %_Ui�� d � p cs 2�e� 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): 61Z20 Appendix B Short Envii-onmental Assessment Form 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 I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1 -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action: Name of Applicant or Sponsor: Telephone: i 0 1 E-Mail: Address: . FJ�1 14 L -e LJ e-5 City/PO: ( State: Zip Code: Jcut 114 A !1 ?0I 1.Does the proposed action only involve the legislative ddoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? / F]If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that Q may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: ❑ 3.a.Total acreage of the site of the proposed action? 6. d acres b.Total acreage to be physically disturbed? . ou acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? G 440 acres 4. Check all land uses that occur on,adjoining and near the proposed ac n" ❑Urban ❑Rural(non-agriculture) ❑industrial EaCommercial esidential (suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland 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 landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: - ff ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES 0 ❑ b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ff ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ❑ b.is the proposed action located in an archeological sensitive area? ❑ 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? Elb.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 F1Wetland El Urban 10/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? ff ❑ 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 noWNO nt sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? DYES ❑ b.Will storm water discharges be directed to established conveyance systems(runIN0 nd storm drains)? If Yes,briefly describe: AYES 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: [A F-1 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: ZI ❑ 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/spons e: kok%W Date: /-2 1, 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 I 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? 11 ❑ 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 ❑ affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: ❑ a.public/private water supplies? El- b.public/private wastewater treatment utilities? El 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, ❑ 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,long-term and cumulative impacts. F] Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Application AFFIDAVIT r i 0 2 1A BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHr`E) 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. Signature of Prope y caner Signature of Property Owner sb� SWORN TO,BEFORE ME THIS G DAY OF , 20 �q fijj;w Notary Public DIANE DISALVO NOTARY PUBLIC-STATE OF NEW YORK No. OID1475593 Qualified In Suffolk County My Commission Expires April 30, 20Z2- APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM 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: (Last name,first name,ipiddle 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%of the s 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 thi b day of Se r4' 200 15 Signaturev a Print Name 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 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 (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# - - PROJECT NAME 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: Location of action: 1090 `'�Pssf S A V O W 5 k✓At—r°W Site acreage: c / Present land use: V t'4-U 4 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: In AL kA (b) Mailing address: I tib.4 1. A—p-e- W�"4 u e 1 `e a✓I (c) Telephone number: Area Code( ) `t 0' (d) Application number, if any: Ift� Will the actio71f ly undertaken,/require funding, or approval by a state or federal agency? Yes ❑ No 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. F]Yes n No Not Applicable Attach additional sheets if necessary Policy 2. Protect and pre rve historic and archaeological resources of the Town of Southold. See LWRP Section III—Poli 'es Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 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—Polic' 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 Page 8 through 16 for evaluation criteria ❑ Yes ❑ No 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 throug Alfor evaluation criteria 1:1 Yes ❑ No [7 Not pplicable 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 riteria. ❑ ❑ Yes No iv of 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 valuation criteria. Yes 1:1 No Not 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., ❑ Yes 11 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 o Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. ❑ Ye❑ No Not Applicable Attach additional sheets if necessary WORKING COAST PVLICIES 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 ❑/ 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. ElYes 1:1No ISIj 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 eva nation criteria. 1:1 Yes 1:1 No Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP Section III—Policies; ages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ❑ Not Applicable PREPARED BY TITLE DATE