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HomeMy WebLinkAboutTR-9657A Glenn Goldsmith,President SOF SO(/jTown Hall Annex Michael J.Domino,Vice-President ,`off Ol0 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III 4 Southold,New York 11971 A.Nicholas Krupski G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 r BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE'OFFICE OF THE BOARD Q . TRUSTEES 12- URS PkI O T COMMENCEMENT OF THS ACTIVITIES CI-E D,OFF :r .4' •i. _ .-i•r„ iii _::r i INSPECTION SCHEDULE Pre-construd&Affl* ei' IitirrYi = irrtain �Si`is.� ��f+ r•:f14::�a1 is f'_._ 1st day of construction f constructed When project complete, call for compliance inspection; Glenn Goldsmith,Piesident �,OF SoUly Town Hall Annex _ y, Michael J.Domino,Vice-President ,`O� ��� 54375 Route 25 John M.Bredemeyer IIIT_`' P.O.Box 1179 Fc; Southold,New York 11971 A.Nicholas Krupski v' G Q Telephone(631)765-1892 Greg Williams �� �� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9657A Date of Receipt of Application: December 27, 2019 Applicant: 1160 Snug Harbor LLC SCTM#: 1000-35-5-39.1 Project Location: 1160 Snug Harbor Road, Greenport Date of Resolution/Issuance: August 19, 2020 Date of Expiration: August 19, 2022 Reviewed by: John M. Bredemeyer, III, Trustee Project Description: Install a 91"x100" hot tub on 10'x10'concrete slab adjacent to northeast corner of patio; for the as-built 6'x30'wood deck; and to incorporate the existing northwest drywell as a means-of hot'tub drainage. 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 John Lupovici, received on July 21, 2020 and stamped-approved on August 19, 2020. 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. Glenn Goldsmith, President Board of Trustees J S C.T M. NO DISTRICT 1000 SECTION-35 BLOCK-5 LOT(S).39 1 ' ,(A�RPR ��'y) _ ®�f� 10253" ,.� y9 S7 -; OAR® .i RUSTEES JUL 2 1 ZO�Q o.(N b SOUTHOL® s w� ®ATSouthold Town AWaSr ?j, Z020AKE a o Tru re STAKE N X75 A \ U P. STAKE PID L' GE O+ O. 56°'7 STAKE\ \ ty7s��� c 1� �w 5 tywei // PROPOSED SPA / \ CONC.PAD��(�`q a•. �pOO d \ 95 `L9 OF'G� 9- ycf T \ GOA FLAGPOLE P,�O V +ry0 ,N G Z ZONE X e� RcP OUP ELEC METER ZONE AE (EL 6) o � GE 125'N RE LINES ALONG MHW UNE �^ GfplaJa� \ •l7'�,Q GNIf 0t'� J o �wti d 556° pt of�GzO 0 7N h� FIRE PIT W/GRAVEL SURROUND a3 QT L mG W O Q S d tz s�Q°tss4 N N zTop OF DANK 61.01' S 18°0938"W UPDATE SURVEY 02-24-20 UPDATE SURVEY 10-20-18 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL FIRM PANEL #36103CO176H LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS AREA. 38,881.21 SQ FT or 0.89 ACRES ELEVATION DA IUM ___ UNAUTHORIZED ALTERATION OR ADDIPON TO THIS SURVEY IS A WOLA77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA77ON LAW COPIES OF THIS SURVEY MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO THE PERSON FOR WHOM THE SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE S7RUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE ERECTION OF FENCES, ADDITIONAL STRUCTURES OR AND 07HER IMPROVEMENTS EASEMENTS AND/OR SUBSURFACE STRUMRES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY EVIDENT ON THE PREMISES AT THE 77ME OF SURVEY SURVEY OF LOT 32, P/0 LOT 33, P/0 RESERVED PARCEL INCL. CERTIFIED TO: JOHN LUPOVICI, JESSICA LUPOVICI, MAP OF:CLEAVES POINT SEC 2 ADVOCATES ABSTRACT, INC, FILED. MARCH 13, 1962 STEWART TITLE INSURNACE COMPANY, SITUATED AT GREENPORT TOWN OF SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design P.O. Box 153 Aquebogue, New York 11931 FILE # 17-177 SCALE 1"=30' DATE NOV. 28, 2017 PHONE (631)298-1588 FAX(631) 296-1588 N YS LISC NO 050882 maintaining the records of Robert 7 Hennessy&He—th M Weyahuk QSuFF01 Glenn Goldsmith, Ij� dent N 'YCt- ; Town Hall Annex Michael J. Domino 54375 Route 25 John M. Bredemeyer III y P.O.Box 1179 A.Nicholas Krupski 0 ® Southold,NY 11971 Greg Williams 4,- �ap�c Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES // ' TOWN OF SOUTHOLD Date/Time: /���� 7�l/.' Completed in field by: 1160 SNUG HARBOR LLC requests an Administrative Permit to install a 91"x100" hot tub on 10'x10'concrete slab adjacent to northeast corner of patio; and for the as-built 6'x30' wood deck. Located: 1160 Snug Harbor Road, Greenport. SCTM#: 1000-35-5-39.1 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 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 s 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: I have read & acknowledged the foregoing Trustees comments,: Agent/Owner: Present were: � J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other W z S.C.T.M. NO. DISTRICT: 1000 SEC11ON: 35 BLOCK: 5 LOT(S):39.1 a 102.53' MAR 9 2020 • � s 1 STAKE 6 1p \ U.P. STAKE 00 GJ�O 0311� ��. O. 0� •l • \ �c,6 VSppO 9��G O��P �� STAKE\ G \ :: '.� �p�::::• ;.•ti m tel' X00 \ gS G� G�.° .. G pRG `t �F / .... y 031 :....:. 00 .' `; \ °A Jo �b Vol GOaG FLAGPOLE oc) °P(�NG � j0, V.0 +gyp TA ZONE X U.P. J,�, o GPS, s � o0 �, 6 ZONE AE (EL 6) 0 12.5'N TIE LINES ALONG M LINE N^ GaJ \ 031`1 aIF OPJ� o `�� 0.7'74• �pN'` N FIRE PIT W/GRAVEL SURROUND a3 Q�1 m G N N z TOP OF irl.90K 61.01 S178 0()9139 11 1780o9'3a,1 vel UPDATE SURVEY 02-24-20 UPDATE SURVEY 10-20-18 THE WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL FIRM PANEL #36103CO176H LOCATIONS SHOWN ARE FROM FIELD OBSERVATIONS AND OR DATA OBTAINED FROM OTHERS. AREA: 38,881 .21 SQ.Fr. or 0.89 ACRES ELEVA77ON DATUM: UNAU7HORIZED AL TERA 770N OR ADD177ON TO THIS SURVEY IS A VIOLA 77ON OF SEC77ON 7209 OF THE NEW YORK STATE EDUCA 77ON LAW. COPIES OF THIS SURVEY MAP NOT BEARING 774E LAND SURVEYOR'S EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN ONLY TO 7HE PERSON FOR WHOM 7HE SURVEY IS PREPARED AND ON HIS BEHALF TO 7HE TITLE COMPANY, GOVERNMENTAL AGENCY AND LENDING INS77TU77ON LISTED HEREON, AND TO THE ASSIGNEES OF 774E LENDING INS77TU770N, GUARANTEES ARE NOT 7RANSFERABLE. 774E OFFSETS OR DIMENSIONS SHOWN HEREON FROM 774E PROPERTY LINES TO 774E STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD17IONAL STRUCTURES OR AND OTHER IMPROVEMENTS. EASEMENTS AND/OR SUBSURFACE S7RUC:TURES RECORDED OR UNRECORDED ARE NOT GUARAN7E•ED UNLESS PHYSICALLY EVIDENT ON 774E PREMISES AT 7HE 77ME OF SURVEY SURVEY OF: LOT 32, P/0 LOT 33, P/0 RESERVED PARCEL INCL. CERTIFIED TO: JOHN LUPOVICI; JESSICA LUPOVICI; MAP OF: CLEAVES POINT SEC. 2 ADVOCATE'S ABSTRACT, INC.; . FILED: MARCH 13, 1962 STEWART TITLE INSURNACE COMPANY; SITUATED AT: GREENPORT TOWN OF: SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING,, PLLC SUFFOLK COUNTY, NEW YORK Professional Land Surveying and Design � + P.O. Box 153 Aquebogue, New fork 11931 FILE 17-177 1"=30' NOV. 28, 201 7 PHONE (681)298-1588 FAX (691) 298-1588 # SCALE: DATE: N.Y.S. LISC. NO. 050882 maintaining the records of Robert I. Hennessy k Kenneth M. Waychuk Michael J. Domino,PI, `ent g11EF©(� i� 0 -aG Town Hall Annex John M. Bredemeyer III,Vice-rresident %, 54375 Route 25 Glenn Goldsmith co a P.O.Box 1179 A.Nicholas Krupsl<i � _ Southold,NY 11971 Greg Williamsy p� Telephone(631)765-1892 wo, �a Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: ,/ ��-v /I '. -D Completed in field by: 1160 SNUG HARBOR LLC requests an Administrative Permit to install an 8'x4" x 7'x7" hot tub on concrete slab of same dimension adjacent to northeast corner of brick patio. Located: 1160 Snug Harbor Road, Greenport. SCTM#: 1000-35-5-39.1 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative V"� 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 completerness/comments/standards: -- �� GyYst/b - G r bv�l (/1BL�C `je1L� �bL� �'t fyY7I�'lif ✓ Gk �yNJ-� s1�� iDL✓`l' �✓.?91 Ll &1 G 2,W 2�.5��o i� �,o v� ���►�.,.. . Nee.�l �e� 5yrvey. I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other Highlife° Collection Hompring GRANDEE" Every day made better® Seating Capacity 7 adults ` w p Dimensions 8'4"x 77"x 38"/2.54m x 2.31m x.97m ;;Y,> k , Water Capacity 450 gallons/1,700 liters Weight 940 lbs./425 kg dry;5,920 Lbs./2,685 kg filled' a;, Jets-43 2 Moto-Massage'DX jets(2) i. }c. _ ��f'a•i.t�.�...,h.���,�:;,",,,� '��'z'"bb"t yisr{.;,�„ ,,.. �•Z R (w/Stainless Steel Trim) 2SoothingStream®jets VJetStream'lets 2 Rotary Hydromassage jets -r 'a 2 Directional Hydromassage lets :?`':,;>, 30 Directional Precision'jets Water Feature BellaFontana'with 3 illuminated arcs of water 'fxr ?a,„ '; 4 9. " '+'<< "t r- ? Water Care System Freshwater'Salt System r, € '» �:, ,•h,w; 3Jt r;Wr, h y.,:F' . :Y;y,,; Ey.i, (Optional) Jet Pump 1 Wavemaster®9000;One-speed,2.5 HP Continuous Duty,5.2 HP Breakdown Torque ✓fir`,``` I W - _ Jet Pump 2 Wavemaster'9200;Two-speed,2.5 HP •' ,• , Continuous Duty,5.2 HP Breakdown Torque Grandee shown with Alpine White shell Circulation Pump SilentFlo 50000 for quiet,continuous filtration Effective Filtration Area 325 sq ft-,top loading Tri-X'filters 100%no-bypass filtration Control System 10 2020'with wireless remote control 230v/50amp, 601­1z,Includes G.F C I.protected sub panel Lighting System Luminescence'multicolor four zone ..1��'-' �fY.-ify/dr �fZ`/ �'F.-'•'�tY!� '.f- - `+ "' O t to ;, ,' £J.r y';fr Heater No-Fault,4000w/230v Energy Efficiency Certified to the APSP 14 National Standard and the California Energy Commission(CEC) In accordance with California law Vinyl Cover 3 5"to 2.5"tapered,2 lb.density foam core,with hinge seal in Chocolate or Smoke Cover Lifter(Optional) CoverCradle',CoverCradle II,Lift'n Glide°or UpRite' Entertainment System(Optional) Wireless Sound System Hot Tub Cooling System CooLZoneTm (Optional) Grandee shown with Alpine White shell Includes water and 7 adults weighing 175 lbs each and Walnut cabinet Export models available in 230v,50Hz,1500w Heater CABINET AND SHELL COLOR OPTIONS ti" Cabinet Colors -j e(I+/,r; 9 r r r ;'Y� //J 1 e I�r i r' e t r�.,,r-" u,`t << �I Shell Colors Alpine White Alpine White Alpine White Alpine White Alpine White Alpine White Ivory Ice Gray Ivory Ice Gray Ivory Ice Gray Ice Gray Tuscan Sun Tuscan Sun Tuscan Sun Platinum Tuscan Sun Platinum Desert Desert Desert No special orders or shell substitutions available. 0 2019 Watkins Wellness` Rev.E Ivvr viEw 6/i5 3 �N ! nl i pi- vf J� `� :r Y ♦ r4� p y .. a � i�i't" K., 14�1'��Fy,rN ,rrR,�ti �,�4+f�`. ,t. ! r �.. � ." v�`G•/ry^'�'r �. °�q'. {(&(,Yn•Yd y�Jy�, A•3 � —r - b Fr -,�� Z`<5t`fr�,�. 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Greenport N 0 Hot-Tub Permit 410C 2 1 Southold Town Southold Trustee: MR.John Bredemeyer Board of Trustees Please find attached the requested revised plan to incorporate the existing dry well on the NorthWest corner of the house as a means of drainage for the proposed hot tub. Please feel free to reach out to me if you require any additional information. Sincerely yo s Jo u ovici MAR 9 2020 'r r Acs w — A- LA _t2e� T .2- - --- ' I i c D com i - t - i Maim Diane From: John Lupovici <drlupo@mac.com> Sent: Wednesday, March 11, 2020 9:42 AM To: DiSalvo, Diane Subject: 1160 Snug Harbor Rd Diane, Thank you for reaching out. Please find the requested information for 1160 Snug Harbor Rd administrative permits Wood Deck 6x30 Spa Dimensions 91"x100" Concrete Pad: 10x10 Please don't hesitate to contact me should you require additional information Regards John Lupovici ATTENTION:This email came from an external source. Do not open attachments or click on links from unknown senders or unexpected emails. 1 OFFICE LOCATION: ®��OF SO(/� MAILING ADDRESS: Town Hall Annex '` ® P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) us ar Southold,NY 11971 ® ®� Telephone: 631 765-1938 Fax: 631 765-3136 C®U 9 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: February 7, 2020 Re: LWRP Coastal Consistency Review for 1160 SNUG HARBOR LLC SCTM#: 1000-35-5-39.1 1160'SNUG HARBOR LLC requests an Administrative Permit to install an 8'4" x 77' hot tub on concrete slab of same dimension adjacent to northeast corner of brick patio. Located: 1160 Snug Harbor Road, Greenport. SCTM#: 1000-35-5-39.1 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is,CONSISTENT with the policies and therefore CONSISTENT with the LWRP. Please verify how the hot tub will be drained. 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 S�yFFO(,- Michael J_ Domino, --sident o�� `� Town Hall Annex John M. Bredemey0ill, Vice-President -y2 54375 Route 25 Glenn Goldsmith U' P.O_ Box 1179 A Nicholas Krupski y Southold, NY 11971 Greg Williams I , � Telephone (631) 765-1892 Fax (631) 765-6641 So(JTHOLDTOWN BOARD OF TRUSTEES TO- -SOUTHOLD TOWN BUILDING DEPARTMENT RE: ' VERIFICATION OF BUILDING DEPARTMENT PER 'T-REQUIREMENTS" S CTM#: J A N" - 2 2020 Property Owner Name: 0 SRO- Date Sent to Bldg_ Dept: The Office of the Board of Trustees is forwarding the above referenced application for veriftcalion'of the Building Department's permitting requirements stated below: YES NO Will the proposed project require a Building Permit? Will the proposed project require a variance determination from the Zoning Board of Appeals? r Will any part of this application be considered a Demolition as described under Town Code? COMMENTS: �bX(gin rieo fe iewer Date V . l SOUS Town Hall Annex Michael J.Domino,President John M.Bredemeyer III,Vice-President 54375 Route 25 P.O.Box 1179 1.3 Glenn Goldsmith Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 Greg Williams Yn- Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application --Z'Administrative Permit Amendment/Transfer/Extension DEC 2 7 2019 � Received Application: I Z-7-7.19 Received Fee: $ 1b0.00 Completed Application: Incomplete: SEQRA Classification: Type I_ Type I[ Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: - Coordination:(date sent):- -LVvrRP Consistency Assessment Form Sent. CAC Referral Sent: Date of Inspection: 2,-,5-2.0 Receipt of CAC Report: Technical Review: 71- Public Hearing Held: 2.IZ.W— Resolution: Owner(s)Legal Name of Property(as shown on Deed): -aw(tra . Lqovuc i Mailing Address: 22 S- t�� NY lav f OQ k C' Phone Number: Suffolk County Tax Map Number: 1000 - 5- Property Location: (if necessary,provide LILCO Pole distance to cross streets, and location) AGENT (If applicable): Mailing Address: Phone Number: Board of Trustees Appl, ' Ltion GENERAL DATA Land Area(in square feet): 2,?s, Fs l • Z Area Zoning: x Previous use of property: Intended use of property: 2��l�,-,J� 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. V0 • a/a 6/11 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? Y 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?�No Yes If yes, provide explanation: . - Project Description (use attachments if necessary): AA m-,aL\ iA - Board of Trustees Appl - Ltion WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: - - -Area of wetlands on lot: CxK- 32 • square feet Percent coverage of lot: . d o( % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 81feet Does the project involve excavation or filling? )(4, —No Yes If yes, how much material will be excavated? 9 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: tt_ Manner in which material will be removed or deposited: otA'r L'.n4 —Tc- ���wDie, M S•-P?"_Ulc 1W cam-.c ",if. ./�• 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): 6I Z20 Appendix B Short Environmental Assessment Form Instructions for Completing Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 3zkk Name of A tion or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action: g �S 7", ?( _ pfi,q,�-r, 1v 1 L Name of Applicant or Sponsor: Telephone: 'W- 66 Y40-3 f Lviov (U E-Mail: -t&LLV a Q) &%,kC. C c Address: 21 'S Pt P-M AvC City/PO: State: Zip Code: r*_t- I jA_ loci 1 1, 1.Does the proposed-action only involve the legislative adoption of a plan,local law,ordinance, _- NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that FJ 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? I 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? ❑ M ❑' b.Consistent with the adopted comprehensive plan? L ❑� 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: 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? ❑ LLJ 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: - 4;J ❑ 10. Will the proposed action connect to an existing public/private water supply? "NO YES If No,describe method for providing potable water:_ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ® ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? (� b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? 'IQM 1 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 ❑Forest ❑Agri culturallgrasslands El Early mid-successional ❑ Wetland El Urban uburban 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? T2 :❑ 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? $NO E]YES b.Will'stonn water discharges be directed to established conveyance systems(rWVff and storm drains)? If Yes,briefly describe: YNO 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: 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 INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/spons e: y _ �iac Date: 17, ZG A�J Signature: Pa 2-1 act Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the.following que tion n Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or othe 'se 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 T 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? 1S4 _- 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? E 8. Will the proposed action impair the character or quality of important historic,archaeological, Q architectural or aesthetic resources? rA —70 - 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 -- - --- -- - - - _ - - No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage �' EIproblems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term, long-term and cumulative impacts. F] Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Appl" Ation AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFAtMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S)AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/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 C^MPLETING 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. gn e f Property Owner Signature of Property Owner S ORN TO BEFORE ME THIS _DAY OF YYI�I' 20 Notary Public TRACEY L CWYER' N6TMW PUBLIC,STATE OF Na'Y`ON K NO.01 DW?6308 00 QUALIFIED IN SUFFOLK COUNTY COMMISSION EXPIRES JUNE 30,?k2yl, APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The'To-,vm of Southold's Code of Ethics prohibits conflicts of interest on the nartof town officers-and employees.The purpose of this form is to provide information which can alert the town of 0ossible confiicts of Interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: L ` J v (Last nWme,first name,griddle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate,the other person's or company's name.) NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone _ Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.)_ Do you personhlly(orthrough yourgompany,spouse,sibling,parent,or child)have a relationship with any,officer-or employee of the Town Vf Southold? "Relationship"includes by blood,marriage,or business interest_"Business interest"iiieans a business, including a partnership,in which the town officer or employee hds even a partial-ownership of(oreniployment,by)a corporation in which the town officer or employee owns ni6«than'5%of the shares. YES _ _ NO I 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:app[ic,1nl (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,p4itner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this d f 200_ Signature Print Na Form TS I y Town of Southold LWRP CONSISTENCY ASSESSIblENT__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- sig_ scant beneficial-and:adverse_effeets-upoii the-coastal°`area'(vhichindludes a1to'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.answea must-be explained-in detail,listing-both-supporting amd-non- sunporiarig-facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall=not-bz-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 I ocal libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM#-yo o PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g.grant,loan,subsidy) (c) Permit,approval,license,certification: Nature and extent of actio) T rS 1 v Location of action:_/M 2- Site acreage: � Present land use: �•5.� - Present zoning classification: 1 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: �'A �,1J u✓ (b) Mailing address: P-r%CF e- r ( W l (c) Telephone number: Area Code �- (d) Application number,if any: j Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 11 No 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 Pest Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Poster 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 I V;RP Section M—Policies; Page 2 for evaluation criteria. Q Yes No F] 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 M 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 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimae loss of life, structures, and natural resources from flooding and erosion. See I.W1It' Section III—Policies Pages 8 through 16 for evaluation criteria YesEl 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 IIT — Policies Pages 16 through 21 for evaluation criteria Yes ❑ No YNot Applicable Attach additional sheets if necessary Policy 6. Protect and restore the duality 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 Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LVVRP 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 LVVRP Section III—Policies; Pages 34 through 38 for evaluation criteria. Yes 1-1 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 LVVRP Section III—Policies; Pages 38 through 46 for evaluation prifprin Ye❑ No Not Applicable Attach additional sheets if necessary WOR]UNG COAST P( __CIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWP.P Section III Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ Nol�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 LNVII_P Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes ❑_ No LIT Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LVV`RP 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 LVVItP Section III—Policies; Pages 65 through 68 for evaluation criteria, ❑ Yes ❑ No Not Applicable PREPARED BY a Jml-`___C7c.��c.tti TITLE �.� DATE �Z Z C (�