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Home My WebLink About860 East Road LLC Michael J.Domino,President vr uvUjsown rine runiex John M.Bredemeyer III,Vice-Pre, it ,`O� �. 54375 Route 25 Glenn GoldsmithP.O. Box 1179 oouthold,New York 11971 A.Nicholas Krupski G Q Telephone (631) 765-1892 Greg Williams 0 Fax(631) 765-6641 �y00UNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD December 10, 2019 David Kilbride P.O. Box 1305 Cutchogue, NY 11935 RE: 860 EAST ROAD, LLC/MURIEL H. KILBRIDE, c/o DAVID KILBRIDE, MANAGING MEMBER 860 EAST ROAD, CUTCHOGUE SCTM# 1000-110-7-23 Dear Mr. Kilbride: As per the written request emailed to our office on December 8, 2019, the Administrative Permit Application for the above-referenced property has been withdrawn. Since personal check#116 from 860 East Road, LLC in the amount of$100.00 was already deposited, enclosed is refund check#1189 in the amount of$100.00. If you have any questions, please do not hesitate to contact the office. Sincerely, ?n4,�� ) 60" Michael J. Domino, President Board of Trustees 1111 1189 TOWN OF SOUTHOLD BOARD OF TOWN TRUSTEES P.O.BOX 1179 SOUTHOLD,NY 11971 50-666-214 DM 12/10/2019 860 East Road, LLC 1 $ 100.00 c PAYTOTEEORDIILOE' One Hundred Dollars and 00/100 ------------------------------------------ DOE.E.AM 8 m�Bridgehampton National Bank I• '�� 54970 MAIN ROAD 1071 A plication 860-E.Tgtpb Coad, LLC 1 p i mR Withdrawn - SCTM 1000-110-7-23 nr u■nn 1 La 4u■ I i'n a 1 Ln r_C C ?ro n gnnn 2n Lu■ Cantrell, Elizabeth From: DiSalvo, Diane Sent: Monday, December 9, 2019 7:59 AM To: Cantrell, Elizabeth Subject: FW:Administrative Permits - From: David Kilbride [mailto:dwkilbride@gmail.com] Sent: Sunday, December 08, 2019 10:12 AM To: DiSalvo, Diane Subject: Administrative Permits Diane - There are Administrative Permit applications in the queue for this month for Allison (820 East Road Cutchogue) and Kilbride/860 East Road LLC. The Trustees visited on 12/4 and advised us not to proceed with the requests. John Bredemeyer recommended withdrawing the applications and he offered to refund the permit fees. Would you please pull the applications from the Trustees' December Agenda and refund the fees to Mrs. Allison and to 860 East Road LLC? Mailing addresses for both are included in the applications but I can provide if you need them. Thanks so much for all of your assistance. David Kilbride P. O. Box 1305 9045 Nassau Point Road Cutchogue, New York. 11935 203-228-o861 (Mobile) -preferred 631-734-2354 (home) dwlcilbride(@gmail.com ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i N 5UR\/EY OF FROPERPr E 51TUATE: GUTGHO(5UE TOWN: SOUTHOLD SUFFOLK COUNTY, NY SURVEYED 0I-23-201- 5UFFOLK COUNTY TAX # ROAD 1000 — 110 — — 23 N8505 20' S�' RM19 MLBRMIS R ICHAM C._RMIE VALLIAM 13'.y a `1 ffr %'jay N RMF- JOHN JAY Kff.BRME Jr. Y PROP05ED GARAGE REGON5TFUr,TIOjy �0� a� � �N 1 V - b9 0 �?O C u T O / � -q O, � � o Y o . .� A o� o,. c60 F� • ti \01f - c=;t" CPO •cam t,� • ,�� 5 032 ��t I OCT 3 1 2019 s15 Southold Town � ( � Board of Trustees �5��( r^.ya rr�f 9MoutMrized mlefad or addillon to a survey ��ppyy ,ry`S mop neamg o Ilaereetl mnd sNv lv sem�s a lolatbn of secibn"12 1, sib-tlF t o i of tta Tak State Educglirn Law' ,{ :t.s.��rn� •only oopres from!ne a-tq or tn.s sw-�ay NOTES: rl H ked w,th an atgr nl of Ge land�r— S �y' SlO�d 58015n0u n¢aan5weree to be wnd true ■ copses' MONUMENT FOUND ^',tr'a�, 'rerf—ip,s and dca tl Freraon slm IU,.ttxs C — survey was prepa¢d n a coda ce With he¢x- �� Isnng rode¢f Fractee �f l NYak Sate A O PIPE FOUND Lt- Sold aertllfcrnaLowotnam5bmtttbnpu�zato,reiyvf tl ePMgnyr¢soorlrVFlaee¢e—dofPitamlp,fnOkteeaneanldd y d¢ u 'to tltitaLA [ S aogeyaMSTAKE SET "ageoIefdgleIrelu t—,anat m tbal tltUliaG JOHN C. EHLERS LAND SURVEYOR Area 21,2b-I SQ FT OR 04G AG?ES - 6 EAST MAIN STREET N.Y.S.LIC.NO.50202 GRAPHIG 5GALE I'1= 40' RIVERHEAD,N.Y. 11901 REF,C:\UsersVohn\Dropbox\17\17-104.pro 369-8288 Fax 369-8287 mica Michael J. Domino, President r��, o�QgVFF0�,4-� Town Hall Annex John M. Bredemeyer III,Vice-Presiaent �� j 54375 Route 25 Glenn Goldsmith o { P.O.Box 1179 A.Nicholas Krupski Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 r- BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: `C r7 :Completed in field b N Y 860 EAST ROAD, LLC, c/o DAVID KILBRIDE requests an Administrative Permit to clear and/or I rune invasive vegetation selectively in a 50'x100' area; replant with beach grass at 18" spacing; all work is 100' or more from mean high water boundary. Located: 860 East Road, Cutchogue. SCTM# 1000-110-7-23 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 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:l () I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: Bredemeyer —ZM. Domino G. Goldsmith N. Krupski G. Williams Other Kilbride O�q'Op 860 East Road, Cutchogue .ss. MR Project area looking south Western section looking south .3r. t Eastern section looking north 20 years ago, north view � �� r�+ I• �1. IiM rto m. P - � 1 1 Fan x�X� e '� °�'^"° t � i °. s e^ t A a,e ae` �. s ale e♦ 4 �� m .; n \/ •t.wcl ]iµq �^• 1 qs�,'l !1' qP P ' q F , t`. ^ e r♦ ,^� i6 .�T] M q apNq 'At I�^K` a °6] d ♦e �J� r ^y q+ `ti`_� ,,t .. `J � ,� o q ,� w s• 1 1 a 0 q s� 'w.ar ap q ♦ �' - - �( °[v¢uatXimwre r``� • 'p ,r,9 1 9 ♦� '� Ar � 't ��. ! a e -yfJ4 � ]exn -"•,r `� °]0 �� M. y \ i aim�, 14 2 At- m�•.0 uHs,swu ,,,.+..+-"'.- �oK` !a T�555 x�r '-"h,�«"" N. ,... � �as� i sorra � - • cevEti�avvE�rro�rv.+w .. � °4r � 1 1Xea �`-' a^^-4 r °i ]SMcI 1 �• � � - � Kay l a 1► +4�1`l �Q'-.. )Y .+- 1 vio FOX t«- e sEE sec.Xo. ,°.wO a 11 IA y � '..._- ,. a• u.r „ 1]r ° a ". n f., � ria.1 +. a t • • 1p ,]! mrrowcr.w°,a,an • �v, � '� '�, r �`�, -....;, COUNTY OF SUFFOLK O N XotiCE x12. ro. ,aao °EcnaXw Reil Property T,x Service A o+ C uaweocy °V-WE of THE w °«w xoun,ota 110 ___ 8 P MEMORANDUM DEC ® 9 2019 Southold Town To: Michael Domino, President Board of Trustees Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: December 9, 2019 Re: LWRP Coastal Consistency Review 860 EAST ROAD, LLC, c/o DAVID KILBRIDE SCTM# 1000-110-7-23 860 EAST ROAD, LLC, c/o DAVID KILBRIDE requests an Administrative Permit to clear and/or prune invasive vegetation selectively in a 50'x100' area; replant with beach grass at 18" spacing; all work is 100' or more from mean high water boundary. Located: 860 East Road, Cutchogue. SCTM# 1000-110-7-23 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 INCONSISTENT with the LWRP Policy 6, specifically: 6.3 Protect and restore tidal and freshwater wetlands. D. Provide adequate buffers between wetlands and adjacent or nearby uses and activities in order to ensure protection of the wetland's character, quality, values, and functions. E. Maintain buffers to ensure that adverse effects of adjacent or nearby development are avoided.- 1. voided.1. Maintain buffers to achieve a high filtration efflciencV of surface runoff. 2 Avoid permanent or unnecessary disturbance within buffer areas. 3. Maintain existing indigenous vegetation within buffer areas. Photos indicate that the area proposed to be cleared is indicative on a quality, maritime habitat with high function and value (wildlife habitat, wave attenuation during storm events, erosion control etc... The parcel is located within a NYSDEC Significant Coastal Fish and Wildlife Habitat Area. Figure 1 below shows the extent of the maritime habitat. The LWRP CCR form indicates the need to clear is to provide "public views". This is incorrect. Views from public vantage points are not expected. The application is deficient in the following areas: 1. The species and types of "invasive" vegetation (trees, shrubs, groundcover) to be cleared are not identified. What is the meaning of the term "invasive" as applied here? NYSDEC maintains a list of invasive species that I have included below. 2. The amount of clearing is not identified. The area is large equaling 5000 square feet. 3. The method of clearing is not identified. 14i • ,a � v a!I L t� x a 1 x Figure 1. Subject parcel and important maritime habitat areas seaward of white line. LWRP policy language recommends the protection of wetland functions and associated benefits regardless of the availability of compensatory mitigation, especially, areas designated as Significant Coastal Fish and Wildlife Habitats. It is recommended to preserve this important maritime habitat that a non-disturbance buffer is created. Clearing of NYSDEC unregulated invasive trees, shrubs and groundcover should not be permitted in this area. 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 6 NYCRR Part 575 Prohibited and Regulated Invasive Species September 10, 2014 PLANTS Prohibited: Acer pseudoplatanus, Sycamore Maple Achyranthes japonica, Japanese Chaff Flower Alliaria petiolata, Garlic Mustard Ampelopsis brevipedunculata, Porcelain Berry Anthriscus sylvestris, Wild Chervil Aralia elata, Japanese Angelica Tree Artemisia vulgaris, Mugwort Arthraxon hispidus, Small Carpet Grass Berberis thunbergii, Japanese Barberry Brachypodium sylvaticum, Slender False Brome Cabomba caroliniana, Fanwort Cardamine impatiens, Narrowleaf,Bittercress Celastrus orbiculatus, Oriental Bittersweet Centaurea stoebe (C. biebersteinii, C. diffusa, C. maculosa misapplied, C. xpsammogena), Spotted Knapweed Cirsium arvense (C. setosum, C incanum, Serratula arvensis), Canada Thistle Cynanchum louiseae (C. nigrum, Vincetoxicum nigrum), Black Swallow-wort Cynanchum rossicum (C. medium, Vincetoxicum medium, V. rossicum), Pale Swallow-wort Dioscorea polystachya (D. batatas), Chinese Yam Dipsacus laciniatus, Cut-leaf Teasel Egeria densa, Brazilian Waterweed Elaeagnus umbellata, Autumn Olive Euphorbia cyparissias, Cypress Spurge Euphorbia esula, Leafy Spurge Ficaria verna (Ranunculus ficaria), Lesser Celandine n- 9 Frangula alnus (Rhamnus frangula), Smooth Buckthorn Glyceria maxima, Reed Manna GrassHeracleum mantegazzianum, Giant Hogweed Humulus japonicus, Japanese Hops Hydrilla verticillata, Hydrilla/Water Thyme Southold Town Hydrocharis morsus-ranae, European Frogbit Board ofTruste s Imperata cylindrica (I. arundinacea, Lagurus cylindricus), Cogon Grass Iris pseudacorus, Yellow Iris Lepidium latifolium, Broad-leaved Pepper-grass Lespedeza cuneata, Chinese Lespedeza Ligustrum obtusifolium, Border Privet Lonicera japonica, Japanese Honeysuckle Lonicera maackii, Amur Honeysuckle Lonicera morrowii, Morrow's Honeysuckle Lonicera tatarica, Tartarian Honeysuckle Lonicera x bella, Fly Honeysuckle Ludwigia hexapetala (L. grandiflora), Uruguayan Primrose Willow Ludwigia peploides, Floating Primrose Willow Lysimachia vulgaris, Garden Loosestrife Lythrum salicaria, Purple Loosestrife Microstegium vimineum, Japanese Stilt Grass Murdannia keisak, Marsh Dewflower Myriophyllum aquaticum, Parrot-feather tl Myriophyllum heterophyllum, Broadleaf Water-milfoil Myriophyllum heterophyllum x M. laxum, Broadleaf Water-milfoil Hybrid Myriophyllum spicatum, Eurasian Water-milfoil Nymphoides peltata, Yellow Floating Heart Oplismenus hirtellus, Wavyleaf Basketgrass Persicaria perfoliata (Polygonum perfoliatum), Mile-a-minute Weed Phellodendron amurense, Amur Cork Tree Phragmites australis, Common Reed Grass Phyllostachys aurea, Golden Bamboo Phyllostachys aureosulcata, Yellow Groove Bamboo Potamogeton crispus, Curly Pondweed Pueraria montana, Kudzu Reynoutria japonica (Fallopia japonica, Polygonum cuspidatum), Japanese Knotweed Reynoutria sachalinensis (Fallopia sachalinensis, Polygonum sachalinensis), Giant Knotweed Reynoutria x bohemica (Fallopia x bohemica, Polygonum x bohemica), Bohemian Knotweed Rhamnus cathartica, Common Buckthorn Rosa multiflora, Multiflora Rose Rubus phoenicolasius, Wineberry Salix atrocinerea, Gray Florist's Willow Silphium perfoliatum, Cup-plant Trapa natans, Water Chestnut Vitex rotundifolia, Beach Vitex Regulated: Acer platanoides, Norway Maple Clematis terniflora, Japanese Virgin's Bower Euonymus alatus, Burning Bush Euonymus fortunei, Winter Creeper Miscanthus sinensis, Chinese Silver Grass Robinia pseudoacacia, Black Locust More information can be found at �)J1((//�\��Y� t� V E V LLQ http://www.dec.ny gov/docs/lands forests pdf/islist.pdf s! =DEC ,.-,.92019SouoTown Board of Trustees Michael J.Domino,President �*qf SOUry� Town Hall Annex John M.Bredemeyer III,Vice-President l0 54375 Route 25 P.O.Box 1179 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski COQ Telephone(631) 765-1892 Greg WilliamsCOUFax(631) 765-6641 �yN'T`I,�� E E01 Ejo] _ BOARD OF TOWN TRUSTEES0 TOWN OF SOUTHOLD OCT 3 , This Section For Office Use Only Southold Town Coastal Erosion Permit Application L____Bar of Trustees Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: o .31 Received Fee: $ Completed Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: —Coordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Name of Property as shown on Deed :ZjLL Owner(s) Legal p y :( ) Mailing Address: • d Phone Number: Suffolk County Tax Map Number: 1000 -1 0�� — oZ Property Location: f&O d 1 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT If applicable): . , � �jc !J'4,,. ( -MaM-1 ON4 { Mailing Address: Phone Number: �� 4 '3oard of Trustees Appli.ca;' ,)n r GENERAL DATA Land Area(in square feet): I Area Zoning: Previous use of property: S , dj..et Intended use ofroe S• G�.G �� p p rty� - 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: Acy Date 1 F4.4 l �oco /0,0,1u No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?_�C No Yes If yes,provide explanation: Project Description (use attachments if necessary): r lk& d all r�. -1 pa e-A 0',,_ A t4)aj on ' &/ /�MAii 3oard of Trustees Applica, ;,n WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Area of wetlands on lot: (00(' 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: 17)12 feet Does the project involve excavation or filling? >5�' No Yes If yes, how much material will be excavated? 1 14 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): lam- oT -n � � 617.20 Appendix B Short Environmenta[Assessment Form Instructions for Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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: -P Project Location(describe,and attach a location Tma ): 1113 Brief Description of Proposed Action: Lot a4 u)'o s Name pplicant or Sponsor: Telephone: D a Addr 1 . d � 130 City/PO: State: Zip Code: 1.Does the proposed action or(If involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regul on? 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)n e and permit or approval: ❑ E] _�J-tlw4�—T�44tlm � 3.a.Total acreage of the site of the proposed action? m acres b.Total acreage to be physically disturbed? + 10 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 ;gQResidential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 5 is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ 9 ❑ b.Consistent with the adopted comprehensive plan? ❑ �J ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ YES 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO If Yes,identify: t4 ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES R1 ❑ 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? f NO YES If No,describe method for providing potable water: A l I m s: �e_.,. El El 11.Will the proposed action connect to existing wastewater utilities?NJA `f NO YES If No,describe method for providing wastewater treatment: T►C ( �j, -� El —16 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? 0 ❑ 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? ❑ 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: 14.9shoreline tify the typical habitat types that occur on,or are likely to be found on t prr sect site. Check all that apply: ❑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 NO YES by the State or Federal government as threatened or endangered? ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? 'R NO ❑YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ❑NO DYES 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: k 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: ❑ Noel 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/sponsor name: Q L� Signature• t 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 ❑ 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? El 1:1 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)? 41 Page 3 of 4 . l 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? Tf, 1 l. Will the proposed action create a hazard to environmental resources or human health? El Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration, irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental ' pa- ts. Town of Southold-Board of Trustees !'fi 1 Name of Lead Agency Date Michael J. Domino President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer ignature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 3oard of Trustees Applicav',>n AFFIDAVIT U�'� V), L, v,) /6 , . /w," NBEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS 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 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 Property Owner j Signature of Property Owner f , SWORN TO BEFORE ME THIS DAY OF e(- , 20 (c7. 01 Notary Public REBECCA A LUCAK Notary Public-State of New York No.01 LU6386882 Qualified in Suffolk County My Commission Expires Feb.04,2023 r � y3oard of Trustees Applica%J =in AUTHORIZATION (Where the applicant is not the owner) I/We, owners of the property identified as SCTM# 1000- in the town of New York,hereby authorizes 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. Property Owner's Signature Property Owner's Signature SWORN TO BEFORE ME THIS DAY OF , 20 Notary Public 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 p9slible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: 1�d (Last name,first name,middle 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 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 �.,,o 2 Signature Print Name Form TS l 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# (DI -�_- Ja PROJECT NAME O' 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: A(X A�, Site acreage: Present land use: i G 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: 'M&74" Aiv&4—oe (a) Name of applicant: ` W IF/,� Je (b) Mailing address7 a [/� Cu" (c) Telephone number: Area Code ---------------- (d) Application number,if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ No De If yes, which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Oyes ❑ 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 VyesE1 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—Policies Pages 6 through 7 for evaluation criteria Oyes ❑ No ❑ Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 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 HI —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No ❑Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not�}._,a)licable _ Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Yes ❑ No [] Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LVWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No5� 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. ❑ Ye�] NoJ Not Applicable Attach additional sheets if necessary WORKING COAST POLIL__a 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 w ters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes 1:1 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 ❑ NoD� Not Applicable PREPARED Y `� �i/� TITLE BDATE\__W (� r