Loading...
HomeMy WebLinkAboutTR-9603A r � r�os xoo ;� Town Hall Annex Michael J. Domino, President ��o �ti John M. Bredemeyer, III, Vice-President {'o 54375 Route 25 Glenn Goldsmith r, N ,z i P.O. Box 1179 A Nicholas Krupskir Southold, NY 11971 y o�Al Greg Williams �ol Telephone (631) 765-1892 Fax (631) 765-6641 SOUTHOLD TOWN BOARD OF TRUSTEES J 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 L Pre-construction, hay bale line/silt boom/silt curtain t 1St day of construction % constructed When project complete, call for compliance inspection; Michael J.Domino,President QF SO�rTown Hall Annex John M.Bredemeyer III,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams �0 �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9603A Date of Receipt of Application: November 4, 2019 Applicant: John Hurley SCTM#: 1000-107-7-10 Project Location: 1535 Westview Drive, Mattituck Date of Resolution/Issuance: December 11, 2019 Date of Expiration: December 11, 2021 Reviewed by: Glenn Goldsmith, Trustee Project Description: Install a 48"x25" generator on a 55"x35" concrete pad. 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 prepared by Louis DeSantis, received on November 4, 2019 and stamped approved on December 11, 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 SCDHS REF # R10-16-097 SURVEY OF PROPERTY RAIN RUNOFFT CONTAINMENT PROPOSED HOUSE + PORCH • 31577. A T MA TTIT UCK 3157 X 1 X 0.17 536.7 GU. FT. � � � TOWN OF SOUTHOLD PKOP05ED DRIVEWAY 706 5Q.FT. NOV 4 2019 706 X 1 X 0.17 120.4 (,U. FT. f SUFFOLK COUNT V; N. Y. 657.1 V.F. 1000-107-07-10 657/42.2 15.6 V.F. PROVIDE 121 DKYWELL5 0 X 6' DEEP ? SCALE: 1'=30' OR EQUAL ' JULY 26, 2010 DRYWELL CONNECT TO HOUSE �,"`';�� WITH GUTTERS + LEADERS ' ON PUBLIC WATER) '' JULY 20, 20JULY 8, 116 ((REV/SS�ONS) OR E PROVIDE Q DKYWELL ATE0FOR6' DEEP DRIIVEWAY yyELLINGS IN 150 _��' /` NG) THIN --' JULY 27, 2016 (PROP. SEPTIC) (D _ _ (j)WELLING) ING)SASEENT) NOVEMBER 21, 2016 (TOPOGRAPHY) CO) II NOVEMBER 28, 2016 (REVISIONS) JANUARY 3, 2017 (REVISIONS) JULY 12, 2017 (PROP.HOUSE) u. i PROP05ED SEPTIC 5Y5TEM N�ONFUSI ONWA�R) , (4 6EDROOMS) MICHAEL.M PUBLIC APPROVED BY [11 1000 GALLON PRECAST 5EPTIG TANK (DWELLING sE 15?•90 �$ �` BOARD OF I r�USTEES 18.5• 131 LEACHING &ALLEYS - 4' DEEP $ H� 6' WITH 3' SAND COLLAR 3' MIN. ABOVE ,►E ASPHALT I E DMF WAyM WELL p LL�NG� TOWN OF SOUTHOLD GROUND WATER =N78.4Z 4OD `r-(-+� ` EXISTING 5EPTIG SYSTEM 76 l �'1 x SST RE�4`�0� �s N "j DATE QSTzolq TO BE REMOVED OR FILLED IN WDOpLRE .TX►+'0 �� If TO 5CDH5 5PEGIFIGATION5 � B u'' - i ,s 5 R�gSED J B 41. _ 111'0. 18 EL. 7.4' EL.8.1 pSp4ALT ` .w pRi1EWAY C7 _DW W,/GRATE W0000 OC Z (RE ) --• �°' '` ' ! , o` 1�1 i-/- Z �o _ �,o °o `.���H s v1i - -/' nN x o 2 I c ,1 c N 0 Bu FLO DOCK = V ` LG r� - , mmU m 511PP (£R U d LY P , M 0 WATER WA (A � Z' j; � 179..�� St,�+PROPC�� �� METE j � , � 1NG 3 O_ Q M P OPOS PRYPOS D , !. h ;1�? , `, O �\ c m VAn w -� 1 Q ` rn DW 00 TEST HOLE DATA �-- NITAR 18 ,8 J a F 3 / S NIBERM P N\ CONR' ! CMF McDONALD GEOSCIENCE I E', E i # - '.r sPHALT EL 71' JUL Y 7, 2010 j 5 n f'o.5' ) EL 17.8' C� ELjp ` T`- Z 9 5 13'w 14 �n15 G ,as• Q� (ac to �"' 4 DARK LOAM OL ® 7.5' i WLLE, e 1.4 TL,13.4 it{*1^ 4140 1' ____ EL /tS:.1f I w ----- 30.5 BROWN SANDY SILT ML 9 of N �� �' N�� Y DIF TRUST BROWN SrL7Y SAND sxr 78.42'40"WZ2 MUELLER F L�'�LWATER) ----- 5• S78-42'40 mb IN ORG G G TH PUB PALE BROWN FINE SAND SP ti G(DWELLIN V 1 '-'-- 15.1'WA7ER IN PALE BROWN RNE SAND SP ----- 16' ___-- 18, WA7ER IN BROWN SILTY SAND SM WA 7ER IN PALE BROWN nNE SAND SP 24' N n =MONUMENT WATER) QO 13' = PROPOSED CONTOURS I IC f_ nN FLOOD ZONE FROM FIRM J610JC0481H WI.D,�IN 150 PURL �Oti Y ELEVA TIONS & CON TOURLINES ARE REFERENCED TO N.G. VD. '29. (DWELLINGS i i i AREA=15,765 SO. FT. TO TIE LINE I am familiar with the STANDARDS FOR APPROVAL SEP 5C SYSTEM DETAIL NOT TO SCALE AND CONSTRUCTION OF SUBSURFACE SEWAGE (EIEVAnONS ARE PROPOSED) a� DISPOSAL SYSTEMS FOR SINGLE FAMILY RESIDENCES F.F. EL 19.2' and will abide by the conditions set forth therein and on the EL 15:0' FINISHED GRADE EL ISO' permit to construct. , 1N✓.� _ �� -11I 2'MAX 1'MIN. r 6'MIN 1'MAX The location of wells and cesspools shown hereon are 1NKEL •12 10 1/4'PER FOOT 11.8' B INK ®® from >Tield observations and or from data obtained from others. MINIMUM PITCH 11.3 ®®� C. N0. 49618 MIN.4'DIA. PIPE 1/8'PER FOOT 1NY.EL ®®®rf 4' / f �� ✓d ANY AL TERA TION OR ADDI 77ON TO THIS SURVEY IS A VIOLA TJON I MINIMUM PITCH 11.1 ®rE 1000 GAL 4'MIN4'DIA PIPE ®�c � PRECAST 1 min. ----����hhh OF SECTION 72090E THE NEW YORK STATE EDUCATION SAW. SEP77C TANK III 3'+ l3) + 1�r d gullies = PECONIC SURVEYORS, P.C. EXCEPT AS PER SEC77ON 7209-SUBDIVISION 2. ALL CER70C.AT7ONS = (631) 765-5020 FAX (631) 765-1797 HEREON ARE VALID FOR THIS MAP AND COPIES THEREOF ONLY IF GROUND M'4TERJ II' ( WATER EL Zr SAID MAP OR COPIES BEAR THE IMPRESSED SEAL OF THE SURVEYOR (HlafEsr Ew,wcTED) ,,l - P.0. BOX 909 WHOSE SIGNATURE APPEARS HER£O,N. TL_ .F5i0-UW1-) WATER 'IGHEST EJECTED) 12JO TRA VELER STREET�Ir-, �!�-I�I;�=ii�lSOUTHOLD, N. Y 11971 10-174 Michael J. Domino, Pre itO�0 COG _ -Town ITall Annex John M. Bredemeyer III,Vice_,. ident yam, ' ' 54375 Route 25 Glenn Goldsmith cm P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams ?', p! _ Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 1 ,/11 Ll 16 Completed in field by: (Q. Louis DeSantis on behalf of JOHN HURLEY requests an Administrative Permit to install a 48"x25" generator on a 55"x35" concrete pad. Located: 1535 Westview Drive, Mattituck. SCTM#: 1000- 107-7-10 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: I II Unlisted Action Type of Application: Pre-Submission '� Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/consultant/application completeness/comments/standards: S41-C,191,E NJ l No s� arVe �nyi�on rrsn�ra� fMQOGI'. I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other R r C� SEE SEC.NO.feD SEE SEC.NO.f00 i'3 PATCH UNE n�•o�ea Y, 1 „ MATdI—.�--- ---�—_UNE * _-----_ �_- --- —____—�—— Y3 a w 8 I 1 a N .� tOAA SOA _ 5EE SEC.NO � ,.]Nc) A f] �arTt.A•r grunt' A.A 000,-oat hII z § (A W5A 13 LwN sanwan • Ndl. Y\ oE.Eire.�rirR�aN. .� s s� z.eA ",r„� <o 1.I P „ O z5 1z7A Q ` e9 ny a, ZM K'' e f A �. P. t m 11.9A 2T ' 12 e.]A / O A •� 1+ I 6 OErEfow[xrroawty R iM ZIA 10� n+Avr iAA e� S .pit` 31O ei Y„•Va is 2e •E, zsA � I 11A1) 9 / 4 F 213 C 3\5 tz �y� SOA R9 ..` ✓ 'm PCL NO. I 8 I' Y ,(. 7s a Aa �." 3w Aa sEE sm No. 114 = II I I "k.) o �. a R 3\A{ ` , .\ �" tee-01-0011 w T 93 P +O3 •4 a \7N' 2Y WTTHUCK I w I • O F ,l 2f1 is MRN dSf 27A(c) I T•°� I t A AA M \ A � ° ��� I - ,lo T NOF 11.1 6 +r I J SOUIHOL / 4�Le� 15 z,o yy� ta.M I 3 74 ly(1 p OS Pt 11 O. \3 �' 3•" �n 8 6 i�c) / / 9 N�� /.eA twa.a r P t l a'� \ ' e fie �•, $ e °+°'' ' I O ' •1 \+1 ' 9 .`+fir ;] p} t \\ _1• I 9'L 1 113 .�/ O J 1 • �� flP' e I "' I g;l a r4_�� .� �O I / FUR PCL NO. 6 'LOI g M � � '� ~� I 1e e. er- r,fi+�. o`er 32 SEE Sc.NO. \ 6 \9 i• ♦ ♦ tJ \ 37 .&A I ,Q 1$a q loJA ez /a tM4GO 2 G I \'+ +9 3 a \ t0 ` + ti\,Y la't� 6 OEYEI.OaBIRwfS iM M1 P oe\arnswrxunfr e Oe ,� \as \e l �,) c�t,• h T]a ro �W ¢Q 2u�1r ; 3 ® .10� / ./ \ ° �' +e 9 b y, 'Fyy u '•RGy ,�e., rq ..2s� �+ a^.- y, r R fi� � W7CN --- ------ s NP •� '6 9L ..o / \ N+ .. W e c^ LARCH �-- UNE Nseaex 'i F SEE 9EC.N0.tte 9 \\ I d .a ar _ fao tm tww aF SoUT,,oL, SECTION NO �c 107 UopertyOTa Service Ag NOTICE CO u SUFFr- Michael J. Domino —`,jsident ��o�� � Town Hall Annex John M. Bredeme;_., Sill, Vice-President o 2 54375 Route 25 Glenn Goldsmith N P.O" Box 1179 A Nicholas Krupskiy Southold, NY 11971 Greg Williams l , Telephone (631) 765-1892 Fax (631) 765-6641 SOUTf-fOLD TOWN BOARD OF TRUSTEES TO: SOUTHOLD TOWN BUILDING DEPARTMENT ; RE., VERIFICATION OF BUILDING DEPARTMENT PERM`T'-REQ`UI'RIEMENTS NOV - 7 2019 - S CTM#: �07-7- lD Property Owner Name: ' r Date Sent to Bldg" Dept-. , 11.7,1q The Office of the Board of Trustees is forwarding the above referenced application for verification of the Building Department's permitting requirements stated below: C YES NO Will the proposed project require a Building Permit? ill the proposed project require a variance determination from the Zoning Board of Appeals?. Will any part of this application be considered a Demolition as described under Town Code? COMMENTS: Aignatuareof Reviewer Date- OFFICE LOCATION: SO MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) CA Southold, NY 11971 �pQ Telephone: 631 765-1938 CoUNT`I,� ' 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: December 9, 2019 Re: LWRP Coastal Consistency Review JOHN HURLEY SCTM# SCTM# 1000-107-7-10. Louis DeSantis on behalf of JOHN HURLEY requests an Administrative Permit to install a 48"x25" generator on a 55'x35" concrete pad. Located: 1535 Westview Drive, Mattituck. SCTM#: 1000- 107-7-10. 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 EXEMPT from LWRP review. A. Structures less than 250 square feet in size that are accessory to existing permitted primary structures, and which accessory structures are greater than 50 feet from a boundary of a natural protective feature and freshwater or tidal wetlands, 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 �. T���•'r Town Hall Annex c� John M.Bredemeyer III,Vice-President t 54375 Route 25P.O.Box 1179 Glenn Goldsmith _ t, Southold New York 11971 A.Nicholas ki Kru sT �- p _ �, Telephone(631)765-1892 Greg Williams j1 Fax(631)765-6641 C®U ? BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application )4 Wetland Permit Application Administrative Permit 5 Amendment/Transfer/Extension NOV 4 2019 Received Application: �I • R Received Fee: S lOD Completed Application:_ IIS -1 Incomplete: SEQRA Classification: Type I Type Il Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: � Coordination:(date sent): LWRP Consistency Assessment Form Sent: I� •lq 4SAC Referral Sent: Date of Inspection: ��i• Receipt of CAC Report: Technical Review: Public Hearing Held: I2•�� Resolution: Owner(s)Legal Name of Property (as shown on Deed): G K !'1 CXA L E Mailing Address: /3-35 wE-4y,E bJ bn ✓E M/ I'4- tAcK New %q/< 11?S7- Phone Number: 9091_13W_ /,FO/ Suffolk County Tax Map Number: 1000 - 107 — o7 — lo Property Location: IS- 3S VeS f•.(j 1'EW OR.i VE I "�IUA 44 �Ac K (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): L O o-i's b a Si9-NTI S -se+•ft-a• / r Mailing Address: _1 D k /RaVJE4 N �d�-dI C EIy7ZK 6aili cl�sS /�• Y //93 Phone Number: fo 3� 3�s" �Da9- C E/� �0 3/- Sas' 6 730 Board of Trustees Appli__ lon GENERAL DATA Land Area(in square feet): —3/7r7' 14; 765 Area Zoning: AF Previous use of property: Intended use of property: ` .,=-IVE�A4Q Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? X Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review ' and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes X 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 X No Does the structure (s) on property have a valid Certificate of Occupancy? X Yes No Prior permits/approvals for site improvements: Agency Date No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? x No Yes If yes,provide explanation: Project Description,(use attachments if necessary): &(&f,4f L49 wAs a�/a o,�ccni rW SS-L 3-� -w Board of Trustees Appli__-;ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: - t-J-34M 1 Area of wetlands on lot: ,foo , __ 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? x No Yes If yes, how much material will be excavated? cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 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): 61 Z20 Appendix B Short Environmental Assessment Form hiMructions for Cotnnletin ; 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 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 / Stt dl- y aNEm 2— &AE RowCIe. LMo�M- r'c�-I Name of Action or Project: L GF—NP-lQA-c L��1E12A'1 v� Project Location(describe,and attach a location map): /6735" V f'vi Ew bf-VO IS t MA Brief Description of Proposed Action: f Name of Applicant or Sponsor: Telephone: (W-37-5-- V oZ 9' /`.JIJU1S [\-,,EJ� S' E-Mai1:�wz,4LEA& -S4ioRE wER Address: E/�f,�/C.CoK /00' o&J 04'a Jq c, Su,46 -5L City/PO: State: Zip Code: C"'Q oRr'ctic.r Ive►,.t A x/93 Al I.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that may be affected in the municipality and proceed to Part 2. If no,continue to question 2. 2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES , If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of 1he site of the proposed action? acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial ,.Residential(suburban) ❑Forest ❑Agriculture ❑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? ❑ FX_1 ❑ 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? ❑ NJ 1 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: W IE1�fi4N d 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? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: _ N. E 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ,n ❑ ` 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? ❑ a 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 ®.Wetland El Urban ,);Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES X 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑YES ® ❑ a.Will storm water discharges flow to adjacent properties? EJ NO b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: DNO []YES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO_ _YES completed)for hazardous waste? If Yes,describe: � ❑ f I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE �1 A pplicant/spo rname: ® Lt-1 S bE Date: NOV Z/It Q0 el 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning a 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 ® ❑ 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? ® b.public/private wastewater treatment utilities? © �' 8. Will the proposed action impair the character or quality of important historic,archaeological, a ❑ 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 1 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? a Part 3-Determination of significance. The Lead Agency is responsible for the completion of Fart 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 f 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. IJCheck 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. FJ 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 1 Board of Trustees Appli . -�.ion AUI'HORfZATION (Where the applicanvis not the owner) f TAcK upLFy owners of the property identified as SCTM# 1000- Z-D 7— D 7-"/D ,in the town of I'& CK ,New York,hereby authorizes - L.. O ucs 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. Pro a Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF M0 -t rr_4 ✓J�� ,20 7,v������rte,Q)TA AT1=0F kl:.k NdC,�,X ©Ii L00033544 Notary Public �c a�]r fl�3 e✓ �Z� �, ....u.. JLll'll9�90�6h-11 ;0.7 iA did Board of Trustees Appl:LI__tion AFFIDAV=IT { H LkR L Lrx — -�-- BEING°DULY SWORN } DEPOSES AND AFFIRMS THAT HEM14IS THE 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 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 APPLICATIONS 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. Si are of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF j"v-ci .�e�' ,20 /q EUG,STATE OF, Notary Public NO,0j1&9aG2054,2 S P G�lED CdJ 8RWIT-OU.-LaY��.?'.s -V qr- ' J , v APPLICANUAGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURJ1,FORM The Town of Southold's-Code ofEthicsprohibits conflicts ofinterest on the,part'oftown bfticers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and itllow it to take whatever action is necessary to avoid same. YOUR NAME: Dfe S+Nu j s, LO u j S (Last name,first name,Oddle 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 a Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official wrap Planning Other �0 J � (If"Other',name the'activity.) �N T e , V_ Do you personally(or through your-company,shouse,sibling,parent,or child)have a relationship with any officer.or employee of the Town ofSotithold? "Relationship"includes by blood,marriage,or business interest."BiMncss.interesl"means a business, including a partnership, in which the town,officer or employee his evert a partial ownership of(or cm�loymcnt by)a cn,rporation in which the town officer or employee owns,ibore than:sib 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 orempioyee or his or her spoUsP,sibling,parent or child is(check all that apply): A)the owner of greater than,5°/u of the shares of the corporate'stock of the',applicant (when the applicant is a corporation);, B)the legal-orbencricialowner of any interest in n non-corporate entity(When the applicant is not ixorporation); C)an officer,director,partner,or employee of the applicant;or D)the actual appl icant. DESCRIPTION OF RELATIONSHIP Submitted thi 4-� ay of Ala 1V44LE-a 2091 Signature, A. 02ipv Print Name- Form TS 1 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# 107 - 07 PROJECT NAME _Z4S1�4XA- -6N 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: f Location of action: l�t/16spVt 1a w D RI V 19 , /lA ffj h ,c l< Site acreage: Present land use: R E r l sN T7� 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: O��'.S (b) Mailing address: W gl N /Ro a9o-- CE��e�10� �r•y ���3 �- r k Telephone number: Area Code (c) Tele p (, ) 6I- 31?S- Z1d27 (d) Application number,if any: 1 1 Will the action be directly undertaken,require'funding, or approval by a state or federal agency? Yes F]. No,N' 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 OAST POLICY, Policy A. 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 F-1 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�IL;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 [7-1 Yes F-1 No ® Not Applicable a Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III-Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No 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. ❑ ❑ ® + 7 Yes No Not Ayylicab_e Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LVVIZP'Section III — Policies t Pages 32 through 34 for evaluation criteria. 0 Yes Q 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 L`VRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes 'F] 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. ❑ YeZ] No Z Not Applicable Attach additional sheets if necessary 1 WORDING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new vaster-dependent uses.in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ED Yes ❑ No '56'p Not Appficabfe 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 LWRP Section III—Policies; Pages 62 through 65 for evaluation criteria. Yes ❑ 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; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No ® Not Applicable PREPARED >3Y W�S WJE LAN-kd' TITLE DATE