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HomeMy WebLinkAboutTR-9660A Glenn Goldsmith,President �QF S (/l Town Hall Annex A. Nicholas Krupski,Vice President �QV' y�lO 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III l�[ Southold, New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 CUUNT`(,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1832C Date: July 7, 2021 THIS CERTIFIES that the erection of a split rail fence approximately 60' long and 3' high running from beachrg ass up to MHW along the side property lines; install generator on raised 6'x7' platform, alongside existing A/C units on side of house, At 1100 Sound Beach Drive, Mattituck Suffolk County Tax Map#1000-99-1-4.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated June 12, 2020 pursuant to which Trustees Administrative Permit#9660A Dated August 19, 2020,was issued and Amended on September 16, 2020 and conforms to all the requirements and conditions of the applicable_provisions of 1aw.,The project for which this certificate is being issued is for the erection of a split rail fence approximately 60' long and 3' high running from beach grass up to MHW along the side property lines; install generator on raised 6'x7' platform, alongside existing A/C units on side of house. The certificate is issued to Chris Cyprus owner of the aforesaid property. Authorized Signature Glenn Goldsmith,President *QF SO!/TTown Hall Annex A. Nicholas Krupski,Vice President ,`O l0 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J. Domino c� G Telephone(631) 765-1892 Greg Williams �� Fax(631) 765-6641 couffill BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: INSPECTED BY: �. �o 11Sr'n,-k Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale line/silt, boom/silt curtain 1St day of construction '/ constructed Project complete, compliance inspection COMME TS: - - C. �v►�� %c, o,ceocb,! c . •vAV pecMi� � 991,0A an4 pians cece,v�a CERTIFICATE OF COMPLIANCE: SQU t yNOM ? a AUG 2 7-2020 1$92 f4vA110tea IIHOW4 REM TO" ' ,` :• a i>n:ease �� -r"'''`> �'sr^ ,{,.°s�� - W �.• t `a t° t ��d�.,.„••'•";'” ARf t.ice`LtFS°i«„d3 �S_� ,.tRrA M AWACCRY AOU.-'UX3 91' ug�g h 'ARC4.0'a°k moi' tYIIat a 6A,=0' r Y�Y?lttt,ttE�ti0 ALL RO LI W AS ` Aa, CO Rafi� 2«-62 = Jt '��' r y �a��"a'�E'Yv -�, �g, ��� L :,. t•�4"�»°.. ��j'.�x §s�1t<t'' - < i,.- " .`, ',< wets, "` pc.�;€+•ia �ytnQ•. 4S.¢_ ,$faw'1 '"� < 14 low i MOF Sir HOLD , ';swz msµqlAU ass sm ee -«. `M(#.RAVM' -MMOLO .i s�x''s%:�k�A`�"�°-�3:iFa'x'.'..t..rFat''�t�.'P�t-,�h2r -' _ ��`�5+tb�t""`'' •'°:!mss" e' Rl ,�.' ALL P;?=•.�.'^:2;$�.tP'Ya:s"Ek?2 .'S I4a$i"+^- ", •. . • •< -' SURVEY OOI':`,'1,6T'43 & PART OfF LUfe.9-2 eft 44,'BLOCK 2 a:. J$$9;•9:?:aafs— A».l90. 9872I�- #; SITUATED'til- .MAMN INLET .Surv' y; 'g and Lend"PIhnning rMa,?...'; iEt`1 'bfit[Kfie Caunty Road Suite.D Rfdge9. N.Y". U901` -<.°.€�A`#"E."Ft?�.�J��1$A' Jpa�14 , 6+Q$�tf�2,�3 SALE; ?" , Jo' DATE, LOT `3130f24,to vlW=92620 bag vim m-1192s RCV°t2lSlt 'a:.��9c��; Glenn Goldsmith,President *QF sorry Town Hall Annex Michael J.Domino,Vice-President �O� OlO 54375 Route 25 P.O.Box 1179-_ John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski C%, Q Telephone(631) 765-1892 Greg Williams 0 �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD September 18, 2020 Chris Cyprus 1100 Sound Beach Drive Mattituckx,NY_,11952. RE 1100 SOUND BEACH DRIVE, MATTITUCK V SCTM#: `1000=99-1-4.2 Dear Mr.�Cyprus:•-- - TK6 following action was taken-by-the-Southold Town-Board-of-Trustees at-their-Regular Meeting held on Wednesday, September 16, 2020: RESOLVED that the Southold Town Board of Trustees APPROVE the Administrative Amendment to Administrative Permit#9660A to increase the raised generator platform to 6'x7' in lieu of the previously approved 4'x5' platform, alongside existing A/C units on side of house; and as depicted on the project plan of Chris Cyprus received on August 27, 2020, and stamped approved on September 16, 2020. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not an approval from any other agency. If you have any,questions, please do not hesitate to contact this office. Sincerely,- President, Board of Trustees Glenn Goldsmith,President �QF SD(/Ty Town Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III [ Southold,New York 11971 A.Nicholas Krupski G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 COUM`I BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE-REQUIRED TO CONTACT,THE OFFICE OF THE BOARD OF TRUSTEES e-• .,..i e.,, a 72 HbUkS PRIOR-t0 COMMENCEMENT OF THE-ACTIVITIES CINE_bAl' i'"I `"BLV.■ ..'ci:. �. t:_ �"i� `�r: .. - .,-" .. .. .. i et 'INSPECTION SCHEDULE ,;. Pte-construc&A;�1+i*A e 11Wgiitb6'66jW0 6di*n OV ", _ 1 st day of construction %2 constructed When project complete, call for compliance inspection; i Glenn Goldsmith,President �QF SOUrTown Hall Annex Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer IIIc[ Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams 0 Fax(631) 765-6641 l�OOUM91,�c� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9660A Date of Receipt of Application: June 12, 2020 Applicant: Chris Cyprus SCTM#: 1000-99-1-4.2 Project Location: 1100 Sound Beach Drive, Mattituck Date of Resolution/issuance: August 19, 2020 ; Date.of Expiration: August 19, 2022 Reviewed by: Glenn Goldsmith, President Project Description: Erect a split rail fence approximately 60' long and 3' high running from beach grass up to MHW along the side property lines; install generator on raised 4'x5' platform, alongside existing A/C units on side of house. 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 Chris Cyprus received on August 12, 2020 and stamped approved on August 19, 2020. Special Conditions: Fence should be no more than 219' from the northwest comer of house (73 yards). 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. 4L Glenn Goldsmith, President Board of Trustees ---- - — - --- -------- - - y ' r Al N k Y.� : > AUS 1 2 2020 z ®. tk e P t r � +t. S> 4 s�.<TJAd x t � u CERTIFIED TO— z 4y >s �.a {m to At r t F ° fS sol � 1 -.-.,_��.� SURVEY OF: LOT 43 & PART OF LOTS 42 & 44, K MAP OF CAPTAIN KIDD ESTATES I r�;.�D ':. i4,1949— ;,Sr.. Sh-. , - SITUATED IN: vAT77TUCK INLET 1,914 Uict il� Courltry r u i TOM OF: SOUTHOLt? SUFFOLK COUNTY, NEW YORK DATE: I01J1108 JOB NO, 808-11828 SCALE: 1" — JO's c. � rg Glenn Goldsmith, Pre int = Town Hall Annex Michael J. Domino, Vice-President 54375 Route 25 John M. Bredemeyer III P.O. Box 1179 A. Nicholas Krupski Southold, NY 11971 Greg Williams Telephone (631) 765-1892 " Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: iVlo / a -7113c Completed in field by: CHRIS CYPRUS requests an Administrative Permit to erect a split rail fence approximately 60' long and 3' high running from beach grass up to MHW along the side property lines; install generator on raised 4'x5' platform, alongside existing A/C units on side of house. Located: 1100 Sound Beach Drive, Mattituck. SCTM#: 1000- 99-1-4.2 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 V 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�j Lz!r. arn, of lei a7 �£ I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / / Present were: d J. Bredemeyer M. Domino ✓ G. Goldsmith N. Krupski .V/G. Williams Other E c E w N� Vs �I\E) APR 19 2011 , E 100 p2 � 10'31'08 ,ABL G 5D. ER MARK 1 3D P TOWN OF SOUTHOLD �1N W P Q) (r� �• ' O • O o LA �W11.D GRAS o NOTE: p \ THIS PROPERTY RESIDES IN FIRM O ZONES AE(EL.12), AE(EL.13) & VE(EL.15) `Ot'E E�, 13) 4- ' NOTE: ' \` THE ELEVATIONS SHOWN REFER TO THE ASS P1-�NE \ON 988 DATUM NATIONAL GEODETIC SURVEY � o a� HAZARD � ( ) p 2'x16' WOOD o \ WALK WAY PWz ' Nc� NOTE: P111- AREA OF LOT IS , 596 o '�2 �1 GA% oFN��` c AREA OF ADJACENT AREA S.F. 13,333 S .F. p,8'e AREA OF EXIST. HOUSE FOOTPRINT INCLUDING N ALL ROOFED AREAS & BALCONY = 3,419 S.F. �lPtt n 1 ' ' wZE 16 CpN �RE - 16 �, $ EXIST. PERCENTAGE OF COVERAGE = 25.6% SEAWARD �- "'"" FRAME NLA AWARD 19.4 Y. - 28.� N FRS pVEa 12 N - - WALt � R 23,5 PtNZ. 1.3E � pew a %4 RVl o 00 S .3'x3.9 � zEP o U�1NG S toR� o _ CERTIFIED TQ:;'-)' 5 W 0.0- 1` � AS;� Z pF•Ft 1 1 pmt r ~ O vcAR) m �t ONUNE * 00 2p.0 61 4 GAN ' Lp RCH R.O. O�R 6'X29 P� 1 J AME THE EXISTENCE 8FGHTS OF WAY Fs�Ep 3.5 fi m v AND/OR EASEMENTS OF RECORD IF ANY, NOT SHOWN ARE NOT 0,1'E '� 1 \ z 3s��• GUARANTEED. ? p o 3� by UNAUTHORIZED ALTERATION OR ADDITION TO THIS SURVEY IS A VIOLATION OF o SECTION 7209 OF THE NEW YORK STATE p �Pt►1E EDUCATION LAW. N10 ,G pRAiN COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS INKED SEAL OR CURS (,t1O�V EMBOSSED SEAL SHALL NOT BE CONSIDERED O-V5730 s 0 RpAE -RE EP 7.84 TO BE A VALID TRUE COPY -_� 1 GUARANTEES INDICATED H EER ON SHALL RUN ONL Y TO THE PERSON FOR WHOM THE SURVEY IS PREPARED, AND ON HIS BEHALF TO THE S�uND B TITLE COMPANY, GOVERNMENTAL AGENCY AND 1, LENDING INSTITUTION LISTED HEREON, AND (5Q' WIDE) TO THE ASSIGNEES OF THE LENDING INSTI- TUTION, GUARANTEES ARE NOT TRANSFERABLE. SURVEY OF: LOT 43 & PART OF LOTS 42 & 44, BLOCK 2 MAP OF CAPTAIN KIDD ESTATES KENNETH H. BECKMAN. L.S. FILED JAN. 19, 1949 - AS No. 1672 SITUATED IN: MA TTI TUCK INLET Surveying and Land Planning 1814 Middle Country Road TOWN OF: SOUTHO,LD Suite D Ridge, N.Y. 11961 SUFFOLK COUNTY, NEW YORK (631) 345-9427 �f FAX (631) 345-9429 DATE: 10/31/08 JOB NO. B08-11828 SCALE: 1" — 30' FINAL SURVEY 4/2/2011 B11-13358 FOUND LOC. WITH ELEVS. 11/9/2010 B10-13104 DIST. SEC. BLK. LOT REV. 3/30/2010 B10-12620 S.C.T.M. N 0. 1000 099 01 4.2 REV. 5/22/09 Bob-12101 REV. 5/1/09 BOB-11935 REV. 12/31/08 BOB-11935 So�No „ E 100 p2 < 10131/Da - N A, 1,.30 PM — q S MPRK � V1 N�GN W P ER c5 �c ZONE vE � � <EL 15� kp W O i Q/ O Z to / • \ GRpss) o NOTE: ( THIS PROPERTY RESIDES IN FIRM 0/ \ ONE PE ZONES AE(EL.12), AE(EL.13) & VE(EL.15) / NOTE: THE ELEVATIONS SHOWN REFER EROSION THE NATIONAL GEODETIC� coPS(�L*NE 1988 DATUM (N.G.V.D. 88) NA 4E 2'x16' WOOD / D o \ wAix WAY N °�P V G FENG/ NA AREA OF LOT IS 30,596 S.F. SNE ARDE 3' x o Z GAREA OF ADJACENT AREA = 13,333 S.F. AREA OF EXIST. HOUSE FOOTPRINT INCLUDING WASE ALL ROOFED AREAS & BALCONY = 3,419 S.F. ' / W 2E 16, GpN RCO GRED Abp 16 �' EXIST. PERCENTAGE OF COVERAGE = 25.6% / FRAME SEAWARD 1,, srEps r �� Y4 WARD Ob.'1' N 1 fRRDECK X2,4 yZ� rc')�r �) � ff• `,�de�1. 2 R 71� v" elk ' .3x3.9 .9 SEP,�pA PME DWEa�\�1G ` (Z Slop"() RAISED 51 4 ,5 TA O CERTIFIED TQ;;yo9 wo N FR NS �1�C.� �LL17• (GAR.) 00 20.0• 6 Y cia �r a Lp CN R.0 ROOF OVER 6 X29 Pj �TT t N O. 49$ `v E 35 m ti �J THE EX/EGrE LQI�Cf � OF WAY f q AND/OR EASEA�EIVTS OF RECORD IF WAIF R ANY, NOT SHOWN ARE NOT O•A '�� 2 '= °�s��a• GUARANTEED. ? o UNAUTHORIZED ALTERATION OR ADDITION r TO THIS SURVEY IS A VIOLATION OF o 41 SECTION 7209 OF THE NEW YORK STATE o � PONE EDUCATION LAW. w 0RA1N COPIES OF THIS SURVEY MAP NOT BEARING10Q�46 THE LAND SURVEYORS INKED SEAL OR cu* W EMBOSSED SEAL SHALL NOT BE CONSIDERED D•2W s 57.30 00 E S1E CURB Sp 1.84' TO BE A VALID TRUE COPY. GUARANTEES INDICATED H EON SHALL RUN CH pR�VE ONLY TO THE PERSON FOR WHOM THE SURVEY Ep 96' C A IS PREPARED, AND ON HIS BEHALF TO THE �O, 1A,D BL TITLE COMPANY, GOVERNMENTAL AGENCY AND V 1, WADE) LENDING INSTITUTION LISTED HEREON, AND (50! TO THE ASSIGNEES OF THE LENDING INSTI- TUTION, GUARANTEES ARE NOT TRANSFERABLE. SURVEY OF: LOT 43 & PART OF LOTS 42 & 44, BLOCK 2 MAP OF CAPTAIN KIDD ESTATES KENNETH H. BECKMAN, L.S. FILED JAN. 19, 1949 - AS No. 1672 SITUATED IN: MA TTI TUCK INLET Surveying and Land Planning 1814 Middle Country Road TOWN OF: SOUTHOLDSuite D Ridge, N.Y. 11961 SUFFOLK COUNTY, NEW YORK (631) 345-9427 FAX (631) 345-9429 DATE: 10/31/08 JOB NO. 808-11828 SCALE: 1 - 30' FINAL SURVEY 4/2/2011 B11-13358 FOUND LOC. WITH ELEVS. 11/9/2010 B10-13104 DIST. SEC. BLK. LOT REV. 3/30/2010 B10-12620 S.C.T.M. N 0. 1000 099 01 4.2 REV. 5/22/09 808-12101 REV. 5/1/09 BOB-11935 REV. 12/31/08 B08-11935 Chris Cyprus 1100 Sound Beach Drive,Mattituck SCTM#: 1000-99-1-4.2 8/11/20 x" AW (dw _ t e. r 0 l > � r� , ' r �� .. .. __ .'� .. .. •- --e. .�.��'�. >.Y _ O.. _ ,� .. ., � • �`tee- - �1 _"l'. e. - yr. ''J_ 'V ��:." _ y ` s•.. ^Y � .fir '� � ate' _. � '�#1� .♦ \- _� y, ,y ' • '9! ! - .:�_ - r4: q Key`. •! 4o•a DiSalvo, Diane From: chris cyprus <cc01 @optonline.net> Sent: Tuesday,June 16, 2020 4:20 PM To:I DiSalvo, Diane Subject: Tire tracks where my kids play Attachments: vehicles tracks jpg Hi Diane, hope all is well by you (it is Chris Cyprus, I am the one asking for the post and rail fence permission for my home at Mattituck beach) I sent the application in last week, hope you have received it. I attached a picture above where u can see all the tire tracks. My granddaughters dug a little pit and made stairs out of rocks, you can see somebody went right by on the side of it: It would be much appreciated if this permit could be expedited Than you very much for all your help, Chris Cyprus ATTENTION: This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. i Ab 40 * ,�•J/�r � , ♦ ` . , 4b46 �� � A ..i 'fw •y . ,.. __ +'ti`s _ .- �_.. J 10 '46 - um A W— A4 t o 11.!1'- . -.11 O @3 9.1 0 14 iwIrTTLICK PARK o DISTRICT 5) 2.M 9A oil 40' M.4A(Q -b 1, IIA 0 ,,T1nI11K 1 a P 2f 12� 0 2 (4) 1 IA(C) 10A4C) FOR FOR SEE MC SEC NO �xw Z'S! 17 3 ———————ZE 14ITCHUNE r.NTCH IN SEE SEC. MI.) 5 a d SECTION NO NOTICE E COUNTY OF SUFFOLK (D K eReal Property Tax Service Agency y (21 G ------- — APoCT No PROPEKrY MAP E P IN N Glenn Goldsmith,President Town Hall Annex Michael J.Domino,Vice-President , _,` 54375 Route _ P.O.Box 11799 John M.Bredemeyer TTI , = AD Southold,New York 11971 A.Nicholas Kru ski ="_` '' '`' P � --. �,'� Telephone(631)765-1892 Greg'Williams ,� _r '�'� Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application Administrative Permit Amendment/Transfer/Extension Received Application: . 4-/z•� Received Fee: to,6-b Completed Application: •14, 0 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: " - 3 Date of Inspection: i Receipt of CAC Report: 7 JUR Technical Review: Public Hearing Held: _- Resolution: t Owner(s)Legal Name of Property(as shown on Deed): - Mailing Address: 1106S61/11 h Cc C l Die, J '12` 7► Phone Number: _ 6 3 (n g I ? L Suffolk County Tax Map Number: 1000 - 01 10iec 0®G 1 ,61 a c k (41a 1d Property Location: fit'0© s®Gt to C� Era C� 0,-, (If necessary,provide LILCO Pole#, distance to cross streets, and location) v A AGENT(If applicable): Mailing Address: 7 4 Ca��l � 1� "' ° I-) 0-e Phone Number: Board of Trustees Applic-__1on GENERAL DATA Land Area(in square feet): Area Zoning: Previous use of property: S1 ti �Gt v� i 41 42 Intended use of property: � 1 /V owm - 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 N0 Does the structure(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date a J IT04 S Gt 1 Tv Q �,��� 1�� C /�1 � L � � LbG�U No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency?K No Yes If yes,provide explanation: Project Description(use attachments if necessary): AJ J S1,0) 14r-qJ fell e, S A, ,Q ci becv A- L ` c V®?C -I v ill 2 Y V V — +4—C 1+CJgJ e 6-&k'ev-a-fid✓' op, Side 0,-� G 1-t K66ed deck! . 4110 be- t Board of Trustees Applic Lon WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: Pro V(d-e— S C.Aye o SPG. -Fav- My 1G� e_ 1 h 0 Lt� cAc_k5, Mo-�dv- ioikef A�_) v Is n d Area of wetlands on lot: ,oQ() square feet Percent coverage of lot:- % Closest distance between nearest existing structure and upland edge of wetlands: ,feet Vl o Closest distance between nearest proposed structure and upland edge of wetlands: _/�//7 _feet Gk a of 1P 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: __ _ A11A Manner in which material will be removed or deposited: A114 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): 617.20 Appendix B Short Environmental 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 1 based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part 1-Project and Sponsor Information 11 C ro s 6 4 I,-_ Name of Action or Project: < I f / AJAf rCt l / ��bt C e__Cly YU l I vl Cf S ,rl9dlv�1 ��Scl� Project Location(describe,and attach a location map): 01 �ttcle) `A/ � Brief De cri tion of Proposed Action: #dd s� t YC)F�� cc T sutull v h e s ,rv-e '4Jd (ZAId e O qJ P 5 Name of Applicant or Sponsor. Telephone: 3 _ r 13`/ ' ck r l.J V-y f E-Mail: e �!!, �r e�%{ e-4 Address: V City/PO: State* Zip-Code: a�h �-�C 1.Does thii proposed action only i volve 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 the 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? 3�Tacres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) []Industrial ❑Commercial (Residential(suburban) ❑Forest ❑Agriculture 0Aquatic 0 Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES N/A a-A permitted use under the zoning regulations? ,l �1• ❑ b-Consistent with the adopted comprehensive plan? �1 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,Qr doTit adjoin a state listed Critical Environmental Area? NO YES If Yes,identify: (,{/ -�`(_ _ LU 2 1 G,�, (,�J ; 71 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? El 0 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: In 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:. /V/111- bs0 EJ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? ® F] b.Is the proposed action located in an archeological sensitive area? ❑ Vi 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 Pr 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: KA Shoreline ❑Forest ❑Agricultural/grasslands ❑Early mid-successional [� Wetland ❑Urban ❑Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed 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, - a 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? K7]NO AYES b.Willstorm water discharges be directed to established conveyance systemsrunoff and storm drains)? If Yes,briefly describe: VSNO MYES 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 Iiquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: - - - Sel Q 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NO YES solid waste management facility? If Yes,describe: ❑ 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or NO YES completed)for hazardous waste? If Yes,describe: I AFFIRM THAT THE INFO ION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE f Applicant/sponsor nam . C�V I J l VQJ Date: /t 0 J.2— o 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 ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ® a ; 3. Will the proposed action impair the character or quality of the existing community? Cl 4. Will the proposed action have an impact on the environmental characteristics that caused the ❑ establishment of 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? I= 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate NA a reasonably available energy conservation or renewable energy op ortunities? Lel 7. Will the proposed action impact existing: EJ a.public/private water supplies? 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? L] 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, r( 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? 14 El 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. t 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 Applics --�.on 'AFFIDAVIT CI_ r rl V'I BEING DULY SWORN DEPOSES AND AFFIRMS T HE/SHE 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. - r Signature ofP'r606 Owner Signature of Property Owner SWORN TO BEFORE ME THIS ___ /() DAY OF , 20 -)-b Notary Public DebomhO lowskl ?w TAW Notary PuW State of New York Na 01086280392 c. Qmli W in Suffolk County Nt1v'iick� •`'` Commission,Explras05/131!20 a/ uuuaa` 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 emtiloyees.The purnosd bf this form is to-provide inforination which can alert'the-tow n of possible conflicts of interest and allow it to take whatever action is. necessary46 avoid,same. YOURNAME: C:v r uS C k Y•t'- (Last name,firstfridne,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 ofZone _ 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 I Lqof >1'e 200 0 U I o Signature Print Name C_h V; C'—49'-'k j I 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#. 1_0 - 0 0 PROJECT NAME So I �a,` J Fe� c e (c Yen r5) 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 e nt� f tt� . I r ` we 0 Prev"o- '�� \ 6/`1d1 v ! ►� 7�� G St `� c�f7' OGI�� Location of action: //00 So !j Cc C DV-, AH( C L..All Site acreage: 31 Present land use: S �C(v►� ��Id Present zoning classification:--- R L1b 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: (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 E. No XJ If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space,makes efficient use of infrastructure,makes beneficial use of a coastal location,and minimizes adverse effects of development. See LWRP Section III—Policies; Page 2 for evaluation criteria. Yes No Q 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 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 ❑ Yes ❑ No F"7 Not Applicable Attach additional sheets if necessary T NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages S through 16 for evaluation criteria -❑ Yes ❑. No 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. Of ❑ ['Zzi VIA Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. F] Yes n No,�K 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 Q 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. Q e� No Not Applicable Attach additional sheets if necessary i WORDING COAST POLICIES 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 F"7' 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. ❑ 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 62through65 for evaluation criteria. 2t t L--1 Yes ❑ No Not Applicable Attach additional sheets if necessary T 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 l PREPARED BC�ri3 , fY TITLE OG(/ Ale DATE (� v