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HomeMy WebLinkAboutTR-9736A Glenn Goldsmith,President QF SO(/� Town Hall Annex 0 Michael J. Domino,Vice-President � �� l® 54375 Route 25 P.O.Box 1179 John M. Bredemeyer III l Southold,New York 11971 A.Nicholas Krupski y ,c G @ Telephone(631) 765-1892 Greg Williams '� �� Fax(631) 765-6641 COUNTI,�ct� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72`HO'URS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED'OFF INSPECTION SCHEDULE Pre-construction,%hay bal'e'lirfe ilt_boom/silt`curtain 1st day of construction constructed �_ When project complete, call for compliance inspection; Glenn Goldsmith,President �rg so Town Hall Annex �® Michael J.Domino �® �® 54375 Route 25 John M.Bredemeyer IIIP.O.Box 1179 lip Southold, New York 11971 A.Nicholas Krupski RZ Telephone (631) 765-1892 Greg Williams �® ®s1F ,• ��la® Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9736A Date of Receipt of Application: October 6, 2020 Applicant: Robert G. & Christine A. Hempel SCTM#: 1000-31-9-17 Project Location: 160 Lakeview Terrace, East Marion Date of Resolution/Issuance: October 28, 2020 Date of Expiration: October 28, 2022 Reviewed by: John M. Bredemeyer, III, Trustee Project Description: To install a 4'x7' 13kw generator to run on natural gas 10' from 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 Robert G. Hempel, received on October 6, 2020 and stamped approved on October 28, 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. &&1 64 Glenn Goldsmith, President Board of Trustees APPROVE® BY MRe �e, 160 Lakeview Terrace, East Marion, NY TOWN OF SOUTHOLD 11939 DATE oc7aW 28� 2o2e 8L Owl .g ID �► �4'� `6 dl �• z s � �► 6 Z �. 1. Proposed 4' x 7' generator site [RED] is 10' from house W.- 2. Propane Tank on survey has since been removed r SVFFO(� Glenn Goldsmith, Pre; nt �O Cp ;T Town Hall Annex Michael J. Domino, Vice-Prv0i�ent ��� GVa - 54375 Route 25 John M. Bredemeyer III o ` _ P.O. Box 1179 A. Nicholas Krupski o Southold, NY 11971 Greg Williams y,� �ap� Telephone Fax (636 92 ) 765 66431) 8 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 'lG" `/ '� Completed in field by: ROBERT G. HEMPEL & CHRISTINE A. HEMPEL request an Administrative Permit to install a 4'x7' 13kw generator to run on natural gas 10' from house. Located: 160 Lakeview Terrace, East Marion. SCTM#: 1000-31-9-17 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footag 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 1� 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: / dy /G-da - yl� , �rr� �� �a �vC I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other Hempel Residence, 160 Lakeview Terrace, East Marion, NY 11939 � h �d A* ra yIr �C% tPA � 4TO �4 1. Proposed 4' x T generator site [RED) is 10' from house 2. Propane Tank on survey has since been removed J ,i SURVEY'"URVEY OF PROPERTY T EAST MARION TOWN OF WOOED SUFFOLK COUNTY, NY d+a 9 ®. 1000-31-09-17 op RR DECEMBER 1, 2095 ZN Yaccarino ®o `- ,, 12/01/2015 c A65-00 10 Yc F 22 ° 0 RiaG Li s � 6<1 ® 0 0� + Q � �F�cF � o COQ F 0.1 �� ��,• �P4ti�- G s�, 1�6 �. 2a Pad �F. �G Al ���8 O r-- 91, -91, i 4 o\�l� �P� ® OCT - 6 2020 0,5 110. AC 0,y —, oF�P '� � ���� �� Pio ,� HEMPEL RESIDENCE-9/30/2020-160 LAKEVIEW TERRACE, EAST MARION, NY FACING NORTHEASTERLY AT PROPOSED ' .... ' GENERATOR LOCATION (WHITE SHEET) I FROM SI DEYARD v„ k i FACING SOUTHEASTERLY AT PROPOSED GENERATOR LOCATION FROM SIDEYARD ''l Town of Southold Tax Map Inquiry (1 0(2) ► o x s A . © c l • 4 �nRestoence A \4 5. N esn r X N 0 P W GENERAC 10/13/16 kW Specifications Generator Model G007171-0,G007172-0 G007173-0,G007174-0, G007176-0,G007177-0, (10 kW) G007175-0(13 kW) G007178-0(16 kW) Rated maximum continuous power capacity(LP) w 71�r, 10,000 Watts" 13,000 Wafts' 16,000 Walls' Rated maximum continuous power capacity(NG) 9,000 Watts` 13,000 Wafts' 16,000 Wafts' Rated voltage 240 Rated maximum continuous load current-240 volts(LP/NG) 413/37.5 54.2/54.2 66.7/66.7 Total Harmonic Distortion Less than 5% Main line circuit breaker 45 Amp 60 Amp 70 Amp Phase .._. ,_. V. .x .. . k ._ 1 Number of rotor poles 2 Rated AC frequency aerrrirrirrnnrwwser.wiwrarr.�esr rrrwrrr 60 Hz Power factor 1.0 Battery requirement(not included) 12 Volts,Group 26P 540 CCA Minimum or Group 35AGM 650 CCA Minimum Unit weight(lb/kg) 338/153 385/175 420/191 Dimensions(LxWxH)in/cm 48x25x29/121.9z53.5x73.7 Sound output in dB(A)at 23 ft(7 m)with generator operating at normal load" 61 65 65 Sound output in dB(A)at 23 It(7 m)with generator in Quiet-Test'"low-speed exercise mode" 57 55 55 Exercise duration 5 min Engine Engine type GENERAC G-force 400 Series GENERAC G-Force 800 Series Number of cylinders 1 2 Displacement 460 cc 816 cc Cylinder block Aluminum w/cast iron sleeve Valve arrangement overhead valve Lifter type Solid Hydraulic Ignition system Solid-state w/magneto Governor system Electronic Compression ratio 9.5:1 Starter 12 VDC Oil capacity including filter Approx.1.1 qt/1.0 L Approx.2.2 qt/2.1 L Operating rpm 3,600 Fuel consumption Natural Gas ft3/hr(m3/hr) 1/2 Load 101(2.86) 154(4.36) 182(5.15) Full Load 127(3.60) 225(6.37) 245(6.94) Liquid Propane ft3/hr(gal/hr)[Uhr] 112 Load 36(0.97)[3.66] 56(1.54)[5.83] 62(1.70)[6.45] Full Load 54(1.48)[5.62] 90(2.45)[9.28] 109(2.99)[11.32] Note:Wel pipe must be sized for full load.Required fuel pressure to generator fuel inlet at all load ranges-3.5-7.0 in water column(0.87-1.74 kPa)for NG,10-12 in water column(2.49-2.99 kPa)for LP sga Fa BTU content,multiply ft3/hr x 2,500(LP)or 0/hr x 1,000(NG).For Megajoule content,multiply m3/hr x 93.15(LP)or m3/hr x 37.26(NG). Controls Two-line plain text multilingual LCD Simple user interface for ease of operation. Mode buttons:AUTO Automatic start on utility failure.Weekly,Bi-Weekly,or Monthly selectable exerciser. MANUAL Staff with starter control,unit stays on.If utility fails,transfer to load takes place. OFF Stops unit.Power is removed.Control and charger still operate. Ready to RunfMaintenlance messages Standard Engine run hours indication Standard Programmable start delay between 2-1500 seconds Standard(programmable by dealer only) Utility voltage loss/Return to utility adjustable(brownout setting) From 140-171 V/190-216 V Future set capable exerciser/Exercise set error warning Standard RurVAlarni/Malntenance logs 50 events each Engine start sequence Cyclic cranking:16 sec on,7 sec rest(90 sec maximum duration). Starter lock-out Starter cannot re-engage until 5 sec after engine has stopped. Smart Battery Charger Standard Charger Fault/Missing AC Warning Standard Low Battery/Battery Problem Protection and Battery Condition Indication Standard Automatic Voltage Regulation with Over and Under Voltage Protection Standard Under-Frequency/Overload/Stepper Overcurreni Protection Standard Safety Fused/Fuse Problem Protection Standard Automatic Low Oil Pressure/High Oil Temperature Shutdown Standard Overcrank/0verspeed(@ 72 Hz)/rpm Sense Loss Shutdown Standard High Engine Temperature Shutdown Standard Internal FaulVlncorrect Wiring Protection Standard Common External Fault Capability Standard Field Upgradable Firmware Standard "Sound levels are taken from the front of the generator.Sound levels taken from other sides of the generator may W higher depending on installation parameters.Rating definitions-Standby:Applicable for supplying emergency power for the duration of the utility power outage.No overload capability is available for this rating.(All ratings in accordance with BS5514,IS03046 and DIN6271).'Maximum kilovolt amps and current are subject to and limited by such factors as fuel BTU(Megajoule)content,ambient temperature,altitude,engine power and condition,etc.Maximum power decreases approximately 3.5%for each 1,000 It(304.8 m)above sea level;and also will decrease approximately 1%for each 6°C(10°F)above 16°C(60°F). GENERAC' 10/13/16 kW Switch Options Limited Circuits Switch Features Model G007172.0 G007174.0 G007177-0 (10 kW) (13 kW) (16 kW) • 16 space,24 circuit.Breakers not included. No.of poles 2 • Electrically operated,mechanically-held contacts for fast,positive connections. Current rating(amps) 100 • Rated for all classes of load,100%equipment rated,both inductive and Voltage rating(VAC) 120/240,10 resistive. • 2-pole,250 UAC contactors. Utility voltage monitor(fixed)' -Pick-up 80% • 30 millisecond transfer time. -Dropout 65% • Dual coil design. Return to utility* Approx 15 sec • Rated for both copper and aluminum conductors. Exercises bi-weekly for Standard • Main contacts are silver plated or silver alloy to resist welding and sticking. 5 minutes` • NEMA/UL 313 aluminum outdoor enclosure allows for indoor or outdoor ETL or UL Listed Standard mounting flexibility. Total circuits available 24 • Multi listed for use with 1 in standard,tandem,GFCI,and AFCI breakers from Tandem breaker capabilities 8 tandems Siemens,Murray,Eaton,and Square D for the most flexible and cost effective install. Circuit breaker protected Available RMS Symmetrical 10.000 Fault Current @ 250 Volts Dimensions *Function of Evolution controller Exercise can be set to weekly or monthly Height Width — —W1 H1 H2 W1 W2 Depth inE67.94 6.75 E76.43 1 10.5 13.5 6.91 cm 26.67 34.18 17.54 Wire Ranges H' Conductor Lug Neutral Lug Ground Lug 2/0-#14 2/0-#14 2/0-#14 -DEPTH I W2-� Service Rated Smart Switch Features Model G007175-0 G007178-0 • Includes Smart A/C Management(SACM)module standard. (13 kw) (16 kW) • Intelligently manages up to four air conditioner loads with no additional No.of poles 2 hardware. Current rating(amps) 200 • Up to eight large(240 VAC)loads can be managed with Smart Management Voltage rating(VAC) 120/240,10 Modules(SMMs). Utility voltage monitor(fixed)* • Electrically operated,mechanically-held contacts for fast,clean connections. -Pick-up 80% • Rated for all classes of load,100%equipment rated,both inductive and -Dropout 65% resistive. Return to utility* 15 sec • 2-pole,250 VAC contactors. Exercises bi-weekly for 5 minutes* Standard • Service equipment rated,dual coil design. ETL or UL Listed Standard • Rated for both aluminum and copper conductors. Enclosure type NEMA/UL 313 • Main contacts are silver plated or silver alloy to resist welding and sticking. Circuit breaker protected 22,000 • NEMA/UL 3R aluminum outdoor enclosure allows for indoor or outdoor Lug range 250 MCM-#6 mounting flexibility. *Function of Evolution Controller Dimensions Exercise can be set to weekly or monthly w, 200 Amps 120/240,1 e r Open Transition Service Rated Height Width Depth Hi H2 W1 W2 in 26.75 30.1 10.5 13.5 6.3 cm 67.94 76.45 26.67 34.3 16.01 H2 H' Wire Ranges Conductor Lug Neutral Lug Ground Lug 400 MCM-#4 350 MCM-#6 2/0-#14 - DEPTH _ -. __--Wz-_..'_ _: Rpm . "roxvu. sff 9cc w. 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R+> O �,�•,,• --•-- .rw.w.�.. --^-- s.� . -... w.N. w+x .Al,<xArwxw, Real Property Tax Service Agency Y °F 31 .. ow m, MUAnL G^M•RIMw•C,NY 1190, M 192 ..� ,._ _.z _ - __ usrr �, was el(F=ur=ouxrcT�w NIPR mw�W1FD • wrwE xo wrr..eanu�—_•—— sff.. -._:.� .. r.�.... -- --... wrs - — �� wnxwr wana'xwmNxsox=r*rw sw ° m •m P Olstwc, 1000 PROPERTY MAP _ --..._may . ;..... Nc.�.±.-^fJ.n!w&•/-s'uraao.e_... ....... _ .:� q OFFICE LOCATION: i � °"rosw MAILING ADDRESS: Town Hall Annex "� � P.O. Box 1179 54375 State Route 25 Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Telephone: 631765-1938 Southold,NY 11971 ;a sur 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 26, 2020 Re: LWRP Coastal Consistency Review of HEMPEL SCTM# 1000-31-9-71 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 LWRP policies and therefore CONSISTENT with the LWRP. 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 Glenn Goldsmith,President , I& Town Hall Annex Michael J.Domino,Vice-President r ' 9 ' 'k' 54375 Route 25 John M.Bredemeyer III .l" P.O.Box 1179 Southold,New York 11971 A.Nicholas Kru ski P a Telephone(631) 765-1892 Greg Williams "a�" 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: 10-6-X Received Fee: $ 106.00 Completed Application: Incomplete: SEORA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: YCoordination:(date sent): LWRP Consistency Assessment Form Sent: �w '--7-bate Referral Sent: Date of Inspection:," - OCT 6 2020 Receipt of CAC Report: I Technical Review: Public Hearing Held: /D.M2 ! Resolution: f Owner(s)Legal Name of Property(as shown on Deed):; 1`•0��� f Coo poi Mailing Address. �� Phone Number: 4- 2 - 4 1�J Suffolk County Tax Map Number: 1000 - O L9® 0-9, 0 01 • 900 Property Location: 160 L�e�C r/1�� 2 � 10�4 J% 0 P (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): /t/ Mailing Address: Phone Number: Board of Trustees Application ® GENERAL DATA Land Area(in square feet): 05 5 c C IP c Area Zoning: . Previous use of property: _ .S (-/j G cc% c� lJ) GAC L C Y Intended use of property: S Gee M I l c� Covenants and Restrictions on property? Yes X 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 req r any demolition as per Town Code or as determined by the Building Dept.? Yes o Does the structure (s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: k A en y ,p`^ Date 0 sOuTdOLO Oc 2;L 1724 FiL C:- No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? X No Yes If yes,provide explanation: Project Description(use attachments if necessary): /J % L k G�pe C G6 1 c (M jm Po (&v 0 r /JA T v (e4 L 411,5 UV l Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 10 (/o GC ( kk F-DJ7-�RvJT OF Area of wetlands on lot: square feet Percent coverage of lot: % - Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: 2� feet Does the project involve excavation or filling? _ No Yes - v 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: ��1t�(1 S T�/y� /)OF Ib 17C DIV T Vit. 60 Manner in which material will be removed or deposited: F1 PCII 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): /V 00 6I Z20 Appendix B Short Environmental Assessment Form Instruc#ions fo'r 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 nd Sponsor Information Z � Name of Action orProjec: C NQ t. N�T� Ie, KvJ � ���q1�2_ v t1iGAc Project Location describe,and attach a location map): Sc-TlVk 47-566,9 , /606 t U1 � ccs (Al Brief Description of Proposed Action: e C 7-2(Q 40 64S CcNc`5 7v � cis Ocd C�` G cN c/�t j09 Fo 0 P/2 fNl Namreeoof Applicant or-&pmTM': - Telephon /S , (fl,6'J 0t3e _ E-Mail:: c C A7/U4:3i Address: r3 3; City/PO: 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 Q 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 peit or ap rove: V/(4 ����r�t met" i ��YS ��c C Q 3.a.Total acreage of the site of the proposed action? a acres b.Total acreage to be physically disturbed? A/14. acresowl c.Total acreage(project site and any contiguous properties)owned _ or controlled by the applicant or project sponsor? acres 4 �x / 1=U00 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial MResidential(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? ❑ LM ❑ 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? ( 1 7. is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES_ If Yes,identify: EJ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ , 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ( (� 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: �QNz Rr\�y r� ( '( ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES a �N_ If No,describe method for providing wastewater treatment: tN'l e R n _ Q r 12. a.Does the site contain a sfructure 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? u ❑ i 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? NA ❑ If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres:, Y 'J 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 ❑Agricultural/grasslands ❑Early mid-successional Wetland ❑Urban ,Suburban 15.Does the site of the proposed action contain any species of animal,or associated habitats,listed NO YES by the State or Federal government as threatened or endangered? (� 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a. Will storm water discharges flow to adjacent properties? ]NO E]YES ® ❑ b.Will stone water discharges be directed to established conveyance systems(rut)off 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)? 1 f Yes,explain purpose and size: FZ ❑ 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 INFOR 1 ION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE 0/12 Applicant/sponsor name: ^ Date: Signature: Pug e/L.( G • nA��1. 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 Targe 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? o 0 r 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 1:1establishment of a Critical Environmental Area(CEA)? EJ 5. Will the proposed action result in an adverse change in the existing level of traffic or affect existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable energy opportunities? 7. Will the proposed action impact existing: a.public/private water supplies? El b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ ,architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ ❑ waterbodies,groundwater,air quality,flora and fauna)? 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 ❑ Elproblems? 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 I 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 Application F 7 AFFIDAVIT Olt ( 1 OP : • 2I 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 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 of Property Owner Signature of Property weer SWORN TO BEFORE ME THIS,_- DAY OF I e otary P BRITTANYA.GENOINO Notary Public,State of New York No.olGE6245154 Qualified in Suffolk noun Commission Expires July 18,20 23 APPLICANT/AGENT/RF,PRESENTi'ATIVE TRANSACTI®NAI,DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. �^ /� (' ,�/ YOUR NAME: ("J( C P�� / `l�'` J in �"6 A (Last name,first name,.Middle initial,unless you are applying in the name of someone else or other entity,such as a company.If so,indicate;the other person's or company's name.) ; NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee Change of Zone Coastal Erosion Approval of plat Mooring Exemption from plat or official map Planning Other (If"Other",name the activity.) Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,marriage,or business interest-"Business interest'means a business, including a partnership,in,which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO X_ 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 00 e Submitted this day of O-C{�17L"v` Signature �/� _4" Print Name 5:2W,>- 0 � Form TS] �7r� APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM T e'Town of Southold's Code -Et ics prohibits conflicts o"'nterest on the pgA of t6wif ofiReis and etn to�ees,The riurp6sepf ,this form iiation which can aleit'the tiiwn'of O i�„W conflicts of interest and'allow_it ttr'take whatever action"is• 'nece`ssary to a"voidsaine - A YOUR NAME �013��'I �. �(c1 P�� (Last name,first name,ipiddle 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 v 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,rnarriage,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 to vn 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. F 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 /V � Submitted this d y of 0C��C Signature Print Name a.o(?ea 6 A ®C-• Form TS 1 f 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 Waterfiont Revitalization Program. A proposed action will be evaluated as to its si Mcant 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 supnortine and non- suppor_ hn facts. If'an action cannot be certified as consistent with the LWRP policy standards and conditions,it-shall notbe.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 E local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION PROTECT NAME (C S ( L f �._ I�Uy (S 6 N,-\,-k4C 6o,41AR4 l) 1;Cz d(jc R�/I-YJ The Application has been submitted to(check appropriate response): Irk �'�(?,4-` G�� Town Board ❑ Planning Board❑ Building Dept. X�'11 Board of Trustees FO p1 fit l/v/ 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity,agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan,subsidy) (c) Permit, approval,license,certification: Nature and extent of action: ]\?PC l C, AUiCID IP/ Location of action: o G .� I Z Site acreage: 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: 1�0�e�~ dcyv6 (b) Mailing address: (c) Telephone number:Area Code (d) Application number,if any: f /48 Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 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 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,,2 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 Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ YesF]- 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 �O Not Applicable Attach additional sheets if necessary Policy 6. Protect and restore the quality and function of the Town of Southold ecosystems including Significant Coastal Fish and Wildlife Habitats and wetlands. See LWRP Section III—Policies; Pages 22 through 32 for evaluation criteria. Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section In — Policies Pages 32 through 34 for evaluation criteria. Yes a No Not Applicable r - f Attach additional sheets if necessary CC 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. 11 Yes 0 No Not Applicable Z { 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. YXI No® Not Applicable Attach additional sheets if necessary 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 W❑ 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 62 through 65 for evaluation criteria. ❑Yes ❑ No Not Applicable 3 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'U Not Applicable PREPARED BY - TITLE 0 W DATE 1 ��� Hempel Residence., 160 Lakeview `terrace., East Marion, NY 11939 Board of Town Trustees Town of Southold Table of contents 1. Original Application for Administrative wetland Permit 2. Original survey and 3 copies 3. 4 copies of site plan ��-� E 4. 4 copies of generator specificationsOCT 6 5. 2 pictures of proposed site 2020 6. Tax map 7. ll ati®