HomeMy WebLinkAboutTR-9718A Glenn Goldsmith,President *QF SO(/jy Town Hall Annex
Michael J.Domino
54375 Route 25
- � ,`O l0
P. 1179
- -
John M.Bredemeyer III O.Box 1
Southold,New York
11971
A.Nicholas Krupski y ,e
G Q Telephone(631) 765-1892
Greg Williams �'� �� Fax(631)765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Permit No.: 9718A
Date of Receipt of Application: June 15, 2020
Applicant: Steven & Deborah Wick
SCTM#: 1000-103-1-19.7
Project Location: 1541 Stillwater Avenue, Cutchogue
Date of Resolution/Issuance: October 14, 2020
Date of Expiration: October 14, 2022
Reviewed by: A. Nicholas Krupski, Trustee
Project Description: Construct a 70'x3' berm located 35'from mosquito ditch and to
plant twelve (12) Leland Cypress trees along the 70' line.
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 Steven Wick, received on September 28, 2020 and stamped approved on October 14,
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
Glenn Goldsmith,President Of S0(/ry Town Hall Annex
54375 Route 25
Michael J.Domino,Vice-President ,`O l0
P.O.Box 1179
John-M.Bredemeyer III
Southold,=New York
11971
A.Nicholas Krupski v'
G Q Telephone(631)765-1892
Greg Williams �� �� Fax(631) 765-6641
COU
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
SOUTHOLD TOWN BOARD OF TRUSTEES
YOU ARE REQUIRED TO CONTACT THE OFFICEOFTHE BOARD OF TRUSTEES
!iHO:URS'PRIOR TO"COMMENCEMENT OF THE ACT'IVITIES_CH��K�'bl� F
''BELOW ;:.f.:,
- INSPECTION SCHEDULE F .,
Pre-con�tructfor ;.Mg bal'e`airie/s[It boo'ffi rpt b rtaih
T4 1st day of construction
constructed
When project complete, call for compliance inspection;
HEAL.1 H 0EPT APPROVAL
�•�, t' r, H S NO -
CG F
SEP Z 81 20
Snutltol'dTo;ln
Board ofTru �e� STATEri�/If:R!I OF if�!'I EPl t'
'4` I e
THE WATER SUPPLY AND SEWAGE DISPOSAL
F THIS !O E H F-SiDeNCE WILL
SYS1 MS
CONFORM TO THE STANDARDS OF THE
A,xSUFFOLK CO. DEPT. OF HEALTH SERVICES.
APPLICANT
SUFFOLK COUNTY DEPT, OF' HEALTH
SERVICES — FOR APPROVAL OF
CONSTRUCTION ONLY
• �� { d e- c �, a T' _ r. �11,i 6Q:0 �
�ED / DATE:
-=BOARD OF 1 IMUS ES H. S. REF. NO,.
Q\ APPROVED:
-TOWN OF SOOT OLD
' <<,r
1.4
®ASE pc,o ` /ZoZD SUFFOLK CO TAX MAP DESIGNATION:
DIST. SECT BLOCK PCL.
OWNERS ADDRESS:
fir-; / DEED-. L. r'i��� P.
TEST F9oLE STAMP
-
;:,,"
1 -�� /7��1//`, �'`�_� ,� � �'4• a-y.,,, -`R_ ` ,� f�L(Sr' (.ihnrrthrrrl•n+J�b�lt�6'�nrtlaf,at.''iatc.j,,.
� "Nr � 1 �yt� - . -'r'-'� j •"'C� �_ ..�- � C�. - f Y�:1�`! �r/�,�� S�citfnn
7?.At of 07U
%tar 11, .
11110'and jtiYa trth ,r s.-1.,f
`7 Ca em6(r all goal
to be at V91 trtat n
mcled Feb. 6 198, Guttranto v Indtn-t^r1
c:� •�L_ only to tfia P(rrvon rot V-011t,-t
'.;t'. -.t ,r '� r•,.f,s; la prounra;t and on hf•.b�:rr-„f:•n�tra
,' ,,4.3';,',,,;.'° ,t ,� � .. ��a .;- i tit}ocomPrny,Qcivnrmn�ttir,l.a�^w•;,�, ..t
�- �,� ��. IonriinQ Inalitultrtn 119t,:4r 1,•trw;,,
`''•v-'�',�,1/{{{,p{s!1 �C ' Z)
i• yJ r '.r 714+ - r. % ''i -�• ,,j. `, / "r;v /,_ /'1 • ,' _rdr :� i�. i i' `fa ie J-6�® / `! �l(lI .Q71 e1L 111P�'J etc ihCt
9L.V t'I f.uA7i�q
1� ���i �/'; r!� •i%cJ�i, 1 ! �-'T -- � � '� / 7 . � 8.5 n Itionrt trivtiCutiortr`,,• :}� X1.,1.,5
.. i ' � •- 1 i � fig{Lt+,' -
•'
t +i�. .� -''i + , � � 'Jt"• //1/ .. % -;',/ _ r+' f' � �, rGr 4.' � -, oJ
SEAL/o1,ky[)!
t?. , t t + / -7 . r-, i. - fit, •;J/l.ld %�/ .J`� d�4 •G� �_ f '`L r'
•�'y'Tf � Y (`s r }l- ,,.• ,r '' fF J/ /� `{ ...,, p ,i�-. 'S �p 7r�t::i :� ✓.- / ./;• -
_r d/y ic` T �/' '1 `-1/ c i ✓ �� f r frl! F'F' �'!1 c 7 i
•/ /� / _ If
i)/./�•if"R 61 4T
RODERICK VAN TUYL, P.C.
. - � +*.:-.. '�`'!',._ .. - •.,^fir` '
LICEPISI;D 'LAN'D SURI/EYORS
GREENPORT NEW YORK
Glenn Goldsmitf •e: nt 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
t Fax (631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
Date/Time: Io/7A Completed in field by: N' KtipSl"'
STEVEN & DEBORAH WICK request an Administrative Permit to construct a 70'x2' berm located 35'
from mosquito ditch and to plant twelve (12) Leland Cypress trees along the 70' line. Located: 1541
Stillwater Avenue, Cutchogue. SCTM#: 1000-103-1-19.7
CH. 275-3 - SETBACKS
WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required
1. Residence: 100 feet
2. Driveway: 50 feet
3. Sanitary Leaching Pool (cesspool): 100 feet
4. Septic Tank: 75 feet
5. Swimming Pool and related structures: 50 feet
6. Landscaping or gardening: 50 feet
7. Placement of C&D material: 100 feet
TOP OF BLUFF:
1. Residence: 100 feet
2. Driveway: 100 feet
3. Sanitary leaching pool (cesspool) 100 feet:
4. Swimming pool and related structures: 100 feet
Public Notice of Hearing Card Posted: Y / N
Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action
Type of Application: —Pre-Submission Administrative Amendment Wetland
Coastal Erosion Emergency Violation Non-Jurisdiction
Survey <_ 5 years: Y/N Wetland Line by: C.E.H.A. Line
Additional information/suggested modifications/conditions/need for outside
review/consultant/application completeness/comments/standards:
-r-
r 004 ra m
I have read & acknowledged the foregoing Trustees comments:
Agent/Owner:
Present were: redemeyer '/"M. Domino G. Goldsmith ✓ N. Krupski
G. Williams Other
Y
uArce uNE 1`.`
MATCH
FOR PCL NO -
�d � _:,,�'�. 1��- ... 1 1 �•: �. �` sEesEc.NO
`..��. �\ � � ' � - � d,. � C 11 _... �^,�-1 \._ _ `.5•�.�,--^F ��;=� l �-' c:zne.a3i.z -_._ � ' ' P �:''
\ . � / m � BoR.... 1e' 0 ,..f ( � `'te=n--" ,f yte✓t '� n �y�.m'� v w s z+''s*
,5✓ I rz
\ • t;4 e ; q ! /'� �\�\��L s4 "' • ,� �SE SRpll a =„`,3= �� 5..-�:s'"-� _
—71
11) 1• // / F .t e e ,o = ,t= s m 2• 1 p,'E
tl-
,.\.�/ s a ° b .+ <9�// \ � 'i-. y ,,All 1 o w . ,e i•`w � �
25
♦ 7 J ✓�
'T sb 'L 'A,�d' ✓ � � O sO.R ' zt gl 4 _ 'ij� 1��"''~� � -\\�
-2 .r
�� e ♦ at -� � � Alt 'H � � � •(� •,� � ` �
� � ♦ as 9 ✓ � �/\ � s �Y r \ ,
l m -
1027A r` -i�._ i mp e 3. RO (sm t •tNcl v � i .:.moi,.
q+ • P � / � c of • °' '•a
2Q 21
291
b- s e / � ioM+ . EMOFi ✓ N d., F�—_��--�— �V- �
.h P J I ,99P t\ ,,� �.�_ ,� ,2. 3t, 39 • ro 3,2 � -'�
-.JE2 I aa7 ab dP8' eA� 9° 8n _ A': �� 55 „ m'� m� ✓n `^`-?3� y o�' Y 2�
P -a aa1 • c ,
27
j, ♦ J d fi� +oe b��� �ri ,�, �'r !\, �. 1.; � "'��.1 :�zs-h•, �,�3' 4 z.,s' u y 5 o i ; WIN PL „(so'1 � $ +�\ --
) a P J P Ma' P ^n\/ /) .nr"'. "' • i BALD /� .26 ��J--
e s
° 4+� ,e P z Zai 7-_s� 3` f i 'r. `' yf '� - `N°' . � •troy ,o fl a
+ e P
e `Y
e 9,+♦a °r d �`�' P a• rR9 _ �/" /i/4.< -� (9) z t C•;s
112
i , 22,
15
daa REsr
`i
� sad �� ✓ m . ' � � / . �/ �
9 '
j �`,'+, a �".,,.° - �� - ♦ ��m �,3 ze0.�� * z d Pia ��C ����'� ln�
FOR PCL
_ SEE SEC.N0.NO. \
J / i
n � • g _
0
,f
uNE
COUNTY OF S uc 8 " NolICE
-
k ... r.. —, - .�� x•{rao�, ,y rS �nR���y », soo,No�o
FF
E
"' a _ 103
sE�,�
1
Cantrell, Elizabeth
From: Steve Wick <swick@timesreview.com>
Sent: Friday, October 9, 2020 6:22 PM
To: Cantrell, Elizabeth
Subject: Hello, Elizabeth -
This is Steve Wick. I have an application on the October meeting for a
berm and 12 Leyland Cypress trees behind my house to serve as a screen.
The trustees were here Wednesday and we discussed the height of the
berm. I believe on my paperwork I said 2 to 2 and half feet. After
discussing this with the trustees,. I'd like to amend that to up to 3 feet.
Thank you.
Steve Wick
ATTENTION: This email came from an external source. Do not open attachments or click on links from
unknown senders or unexpected emails.
i
OFFICE LOCATION: MAILING ADDRESS:
Town Hall Annex P.O. Box 1179
54375 State Route 25 Southold, NY 11971
(cor. Main Rd. &Youngs Ave.)
Southold, NY 11971 ° Telephone: 631 765-1938
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: October 9, 2020
Re: LWRP Coastal Consistency Review of STEVEN & DEBORAH WICK
SCTM# 1000-103-1-19.7
STEVEN & DEBORAH WICK request an Administrative Permit to construct a 70'x2' berm located
35' from mosquito ditch and to plant twelve (12) Leland Cypress trees along the 70' line. Located:
1541 Stillwater Avenue, Cutchogue. SCTM#: 1000-103-1-19.7
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 policies and therefore INCONSISTENT with
the LWRP.
The purpose of the planting has not been stated. Trees would be planted in a wetland system as
shown on the survey and not enough information has been provided to adequately assess the
action.
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
-e r
DiSalvo, Diane
From: Krupski, Nick
Sent: Monday, September 28, 2020 12:34 PM
To: DiSalvo, Diane
Subject: RE: 1541 Stillwater
Ok so that is a little confusing. based on our prior conversations he is only applying for the 2'berm 70 feet long and the
trees.Which after talking to Glenn would make it an administrative permit. He will then apply for the rest at a later date.
Let me know if you have any more questions
From: DiSalvo, Diane
Sent: Monday, September 28,202010:58 AM
To: Krupski, Nick
Subject: 1541 Stillwater
See attached from Steve Wick—after your conversation with him.
Liz and I are thoroughly confused.
Can you explain what he is actually applying to do now?
Diane DiSalvo
Southold Town Trustees
54375 Route 25
P.O. Box 1179
Southold, NY 11971
(631)765-1892
(631) 765-6641
1
SEP 2 8 2020
� S �^rn
BofIntees
n �
W SU*KlAA . s, �
� Y
f
f0 -70e-'--
o
vt f4n,/-4
V I�
0
Glenn Goldsmith, President *QF SO(/ry Town Hall Annex
Michael J. Domino,Vice-President ,`O� Ol0 54375-Route 25
P.O.Box 1179
John M. Bredemeyer III [ Southold, New York 11971
A.Nicholas Krupski G Q Telephone(631) 765-1892
Greg Williams �O �� Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
TO: SOUTHOLD TOWN BUILDING DEPARTMENT
RE: VERIFICATION OF BUILDING DEPARTMENT PERMIT REQ IRS MPNTS�,-�N,f
f
Al
SCTM#: JUN 2 5 2020
Property Owner Name:
VVl GSC • , _ ,
r BUTTIPiNG DEFT.
Date•Seht to Bldg. Dept:
The Office of the Board of Trustees is forwarding the above referenced application for
verification 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?
Will any part of this application be considered-a.Demolition
as described under Town Code? -
COMMENTS:
-LYU
nature of eviewer Date
Glenn Goldsmith,President 0 Town Han Annex
Michael J.Domino,Vice-President �� ' ori ,'. ��f> 54375 Route 25
- P.O.Box 1179
John M.Bredemeyer III Southold,New York 11971
A.Nicholas Krupski '✓' ;4 Telephone(631)765-1892
Greg Williams Fax(631) 765-6641
BOARD OF TOWN TRUSTEES
TOWN OF SOUTHOLD
This Section For Office Use Only
A Coastal Erosion Permit Application
t� etland Permit Application
M''" A �aLn
dministrative Permit
Amendment/Transfer/Extension
Received Application:, . 6.15 ZO JUN 1 5 2n7.0
Received Fee:-$, --
Completed Application: •ZS.ZD ------- - f
Incomplete:.
SEQRA Classification: Type I Type II Unlisted Negative-Dec:" - Positive Dec.-z
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: .
Owner(s)Legal Name of Property (as shown on Deed):- inf."
Mailing Address:,.. - () ' E)r �1 p ur
Phone Number: (��1 Y-
Suffolk County Tax Map Number: 1000 - 1-_e, -
Property Location: `,—:kAw4. Air C v l V_4 jov. Y
(If necessary,provide LILCO Pole#, distance to cross streets, and location)
AGENT(If applicable):
Mailing Address
Phone Number: -
Board of Trustees App, cation
GENERAL DATA
Land Area(in square feet): AS
( AS f
Area Zoning:! ► �'''f
Previous use of property: (n
Intended use of property: ov t ? -
Covenants and Restrictions on property? Yes __ZNo
If"Yes",please provide a copy.
Will this project require a Building Permit as per Town Code? 4" 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 4-C Lv i (( A<rN®'--e 4—Ce c(S Jecf,-
Does the structure (s) on,property have a valid Certificate of Occupancy? !/ Yes No
Prior permits/approvals for site improvements:
Agency Date
r/1 Lit; (0 1"? �4t
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): Lz< NV C !N woo
d(! 4CA— et:f40of LJ i Ite va✓
Board of Trustees App:�\--ration
GENERAL DATA -e
Land Area(in square feet): �0� fir' 6 CSC / °1
Area Zoning:. ILAV, ✓I'��
Previous use of property:
Intended use of property:
Covenants and Restrictions on property? Yes _ZNo
If"Yes",please provide a copy.
Will thisp roject 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 10 No
If"Yes",please provide copy of decision.
Will this project require a 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:
Agency Date
Xv 1,4 v e A-e
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): leeu
S W ` a•� <w
Board of Trustees App; ation
GENERAL DATA
Land Area(in square feet): 4 'r
Area Zoning:
Previous use of property: ..
Intended use of property: Y�Uv o r
Covenants and Restrictions on property? Yes 1�No
If"Yes",please provide a copy. .
Will this project require,a Building Permit as per Town Code? Yes 40"<o
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 , - V No
If"Yes",please provide copy of decision.
Will this project require andemolition 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:
Agency Date
No prior permits/approvals for site improvements. v J&%" �`�'T �D�`/<<d M!ffi
agency?Has any permit/approval ever been revoked or suspended by a governmental 4- No Yes
If yes,provide explanation: ;
Project Description use attachments if necessary):
I/.-welffeA-
-71c %
raw. r ur t� G��t •�' �� Cl, k
Board of Trustees App ration
WETLAND/TRUSTEE LANDS APPLICATI®N DATA
V �
Purpose of the proposed operations:
4:,c�,Oe
Area of wetlands on lot: square feet
Percent coverage of lot: , _ ? % _ rb
U
Closest distance between nearest existing structure and upland edge of wetlands: feet
Closest distance between nearest proposed structure and upland edge of wetlands: _ feet
Does the project involve excavation or filling? No Yes
If yes, how much material will be excavated? cubic yards tA 41.
How much material will be filled? tv+i- cubic yards
Depth of which material will be removed or deposited: _ feet
Proposed slope throughout the area of operations: �(c P��
Manner in which material will be removed or deposited:
W a 4�e�1 V.SitM mac.• -
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):
P C
Board of Trustees App ration
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: . Gi
A/,,( 6 Gllt /04- vt-. /,ateV
Area of wetlands on lot: square feet
Percent coverage of lot:
SG -/0
Closest distance between nearest existing structure and upland edge of wetlands: feet
Closest distance between nearest proposed structure and upland edge of wetlands: , feet
Does theJ ro'ect involve excavation or filling? No Yes
p g
If yes,how much material will be excavated? cubic yards
How much material will be filled? o 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):
r Board of Trustees App ration
WETLAND/TRUSTEE LANDS APPLICATION DATA
Purpose of the proposed operations: ct, b
Area of wetlands on lot:� '� '� square feet
Percent coverage of lot: / 0 % p K pp
U U —/V V�t�
Closest distance between nearest existing structure and upland edge of wetlands: fee
Closest distance between nearest proposed structure and upland edge of wetlands: Gffeet
Does the project involve excavation or filling? . .No Yes
If yes,how much material will be excavated? cubic yards
How much material will be filled? cubic yards
Depth of which material will be removed or deposited:_ feet
Proposed slope throughout the area of operations:
Manner in which material will be removed or deposited:
Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by
reason of such roposed operations (use attachments if appropriate):
L' 1VO � 00q f4e. W404 4,11.
w-NP4,jil.I <
�Vt� r�-c
Board of Trustees App'-~ ration
AFFIDAVIT
BEING 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 REPRESENTA'T'IVES, 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
Sign tore of Property Owner Signature of Property Owner
SWORN TO BEFORE ME THIS DAY OF kLfl e 20 o�� _
Notary P61ic,
LYNDSEY BARKER
NOTARY PUBLIC,STATE OF NEW YORK
No. 01 BA6156676
Qualified in Suffolk County
Commission Expires November 27,20;'
61 Z20
Appendix B
Short Environmental Assessment Form
Tnstiructions'for Comnletin
Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses
become part of the application for approval or funding,are subject to public review,and may be subject to further verification.
Complete Part I based on information currently available. If additional research or investigation would be needed to fully
respond to any item,please answer as thoroughly as possible based on current information.
Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful
to the lead agency;attach additional pages as necessary to supplement any item.
Part 1 -Project and Sponsor Information
Name of Action or Pro ec :
rr
Project Location(describe,andattachalocation map):
�f� ✓x.C/V CJ 0v/1 h 0L4J'e
Brief Description of Proposed Action: / L S
A IJ�' �,. i �� �� e.,
Name of Applicant or ponsor: / Telephone: 1 s
feur 1 �/ E-Mail,, _
Address:
a� PS (_LIC .,
City/P0:� � � �� State: Zip Code:
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
_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:
olb 64..' V"o
--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 it.0 P
or controlled by the applicant or project sponsor? .acres
4. Check all land uses that occur on,adjoining and near the proposed action.
E]Urban El Rural(non-agriculture) ❑Industrial ❑Commercial El Residential(suburban)
❑Forest griculture ❑Aquatic ❑Other(specify):
❑Parkland
Page l'of 4
5. is the proposed action, NO YEO N/A
a. A permitted use under the zoning regulations?
b.Consistent with the adopted comprehensive plan?
6. is the proposed action consistent with the predominant character of the existing built or natural NO YES
landscape? ❑
7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES
If Yes,identify:
' 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? F
c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? VF
9.Does the proposed action meet or exceed the state energy code requirements? NO YES
If the proposed action will exceed requirements,describe design features and technologies:
10. Will the proposed action connect to an existing public/private water supply? -NO YES
If No,describe method for providing potable water: ❑
11.Will the proposed action connect-fo existing wastewater utilities? NO YES
If No,describe method for providing wastewater treatment:
F];
12. a.Does the site contain a structure that is listed on either the State or National Register of Historic 01 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? L j
b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody?
If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:
14. Identify the typical habitat types that occur�,on,or are likely to be found on the project site. Check all that apply:
El Shoreline ,..
Shoreline
Forest E§;
gricultural/grasslands ❑Early mid-successional
❑ Wetland El Urban E]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
a.Will storm water discharges flow to adjacent properties? VNO ❑YES
b.Will stortit water discharges be directed to established conveyance systems(EuEqjff 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:
T
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:
1 AFFIRM THAT THE INFORM TION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY
KNOWLEDGE f
Applicant/sponsor name: _ �� v'I Date: ���+f ( ° y
Signature:-
Tart
ignature:-,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
a.public/private water supplies? U
b.public/private wastewater treatment utilities? El J
Ki
8. Will the proposed action impair the character or quality of important historic,archaeological, a
architectural or aesthetic resources?
9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands,
waterbodies,groundwater,air quality,flora and fauna)? rl
Page 3 of 4
- No,or Moderate
small to large
impact impact
may may
occur occur
10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage
problems? ❑
11. Will the proposed action create a hazard to environmental resources or human health? ;❑
Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every
question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular
element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3.
Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by
the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact
may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring,
duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and
cumulative impacts.
QCheck 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.
F] 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)
PRINT7, Page 4 of 4
APPLICANT/AGENT/REPRESENTATIVE
TRANSACTIONAL DISCLOSURE FORM
T_he Towri of Southold'§Cone df Eihies,urohiibits conflicts ofinteresi on,tlie part of town officers Find efriployees"The n1—u'rpase�6f
,this form•is to-.12rovide1riforination•whieh can alert the town iifpossible eonflidfs'ofif►tgtand allow it'to•take whsite'ver:acklon is1
P �necessary 4o avoid same._ .. - - -_ ere.-
YOUR NAME: S .cue_ � � '
(Last name,first n e,§piddle 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 day o,€ 200_
Signature
Print Name
Form TS 1 art
Town of Southold
LWRP CONSISTENCYASSESSMENT FORM
A. INSTRUCTIONS
L,, 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, evduat6d 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,.Mplained.in detail,-listing both supporting and non-
sunportinL:facts: Ifan--ac on cannot be certified as consistent with the LWRP policy,standards and
conditions,it shaft,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# 10VO
PROJECT NAME
The Application has been submitted to (check appropriate response):
Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees LL
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) ,Q
(b) Financial assistance(e.g. grant,loan, subsidy)
(c) Permit, approval,license,certification:
Nature and extent of action:
Location of action: g"�c /v`
Site acreage,: VfA4 ON / oT
Present land use: ��
Present zoning classification:
2. If an application for the proposed action has been filed with the Town of Southold agency, the following
information shall be provided:
(a) Name of applicant:
(b) Mailing address:
(c) Telephone number: Area Co&67 l) �l(' l�
(d) Application number,if any:
Will the action be directly undertaken,require funding,or approval by a state or federal agency?
Yes ❑ No[�K 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 LVV RP Section III—Policies; Page 2 for evaluation
criteria.
es ❑ No ❑ Not Applicable
Attach additional sheets if necessary
Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See
L;pL�V1SP ection 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 ❑ 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 LVVRP
Section III—Policies Pa s-8 through 16 for evaluation criteria
❑ Yes I„ 1 No Not Applicable
Attach additional sheets if necessary
Policy 5. Protect and improve water quality and supply in the Town of Southold. See LVVRP Section III
—Policies Pages 16 through 21 for evaluation criteria
D Yes No J 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 LVVRP Section III—Policies; Pages 22
through 32 for evaluation criteria.
Yes No A 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.
Yes 0 No of Applicable
Attach additional sheets if necessary
Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous
substances and wee LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria.
Yes F1No 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�- PP
No ZNot A licable
-
Attach additional sheets if necessary
} I
WORIENG COAST 1 _-,ICIES
Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in
suitable locations. See LWRP Section M.—Policies; Pages 47 through 56 for evaluation criteria.
❑.Yes ,❑ No 'Not Applicable
Attach additional sheets if necessary
Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic
Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria.
TJYes ❑ No 12 blot Applicable
Attach additional sheets if necessary
Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section M—Policies; Pages
62 through 65 for evaluation criteria.
F Yes ❑ ev
No 4c1 Not Applicable
Attach additional sheets if necessary
Policy 13. Promote appropriate use and development of energy and mineral resources. See LWRP
Section III—Policies; Pages 65 through 68 for evaluation criteria.
❑ Yes ❑ No Not Applicable
PREPARED BY � TITLE. _ DATE
Fr
1 � 2020
Southold Town
Board ofPg�
® fir' d✓� S� - ��6�
t o., 6 AAA.
OV
d Le
tJOA.00,L/4
lAd
�f e
B 6�