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HomeMy WebLinkAboutKubryk, Steve FORCHELLI, CURTO, DEEGAN, SCHWARTZ, MIMEO, COHN & TERRANA, LLP COUNSELORS AT LAW THE OMNI ; '333 EARLE OVINGTON BOULEVARD,SUITE 1010 , UNIONDALE,NEW YORK 11553 TELEPHONE-(516)248-1700 FACSIMILE.(516)248-1729 WEBSITE:WWW FORCHELLILAW.COM JEFFREY D.FORCHELLI MANAGING PARTNER DIRECT DIAL (516)812-6200 MELVILLE,NEW YORK DIRECT FACSIMILE (866)522-1239 BY APPOINTMENT ONLY JFORCHELLI@FORCHELLILAW COM July 19, 2010 Board of Trustees Town of Southold P.O. Box 1179 Southold,New York 11971 Re: Lot 6, Map of Re-Subdivision of Block"F" of the Map of Reydon'Shores Suffolk County Tax Map No. District 1000, Section 80, Block 3 Lot 15 Lake Drive, Southold,;New York("Subject Property") Dear Members of the Board: My wife and I are the owners of.4051Lake Drive;-Southold,which is adjacent to and east of the Subject Property. I understand that'an application may have been filed for the construction of a dock on the Subject Property. In the event that such an application has been filed, I would expect that, as the adjacent property owners, we would be notified of same if there is a hearing. This last weekend, when we were at our house, we saw stakes in the water which would appear to be located at an extension of the north/south property line between our property and the Subject Property. I was also advised by a neighbor that a Town Agency recently inspected the Subject Property. Kindly advise me if such an application has been filed. Yours truly, r E D. FO CHELLI � JDF/ka C E Q W, I' {�`+ ,i I1 J U L 2 0 2010 Southold Town Board of Trustees - f� • Y fj � • � ll,Ste'• C.. 4' } t } 1 G YW^J PROPOSED FIXED DOCK I t 1 JUN 2 9 2010 aw 4 Southhold Town PROPERTY LINE Board of Trustees Ak ,. ? F. PROPERTY MAILING ADDRESS OF NEl/1/ y 355 LAKE DRIVE Q SPF`( 1. 8UT��,a'p�� v SOUTHOLD, N.Y. I Ig71 /� 9 K a C CA ale V iv ,,�, .r �,: � np,. � ,- � �'�• PROJECT DISGRIPTION: PROPOSED FIXED DOCK AMU . ., APPLICANT NAME: STEVE KUBRYK ' GONSULTANT NAME: JEFFERY T. BUTLER, P.E.,P.G. p �; s DATE PREPARED: 10— — ' �AR 02 Og x. s AERIAL VIEW PROPOSED PRIVATE DOGK 3 55 LAKE DRIVE, BAYVIEV4, NY S.G.T.M. 1000-80 03 15 WB � WATER BODY: YACHT BASIN COUNTY OF SUFFOLK TOWN OF SOUTHOLD T JEFFREY T. BUTLER, P.E., P.C. fn w m P.O. BOX 634 = wa. F SHOREHAM, NEW YORK TEL (051.208> 88>50 FAX 631 72 7 8033 + iY :siHISV L "Z -A JOB No. 080056 - oG YACHT BASIN Moog F ROPpZEN g EX. FLOATING ,," gf y'wr 011111/ / IXEb Don ED DOCK W/ RAMP PIZOP05ED V. � y4 � 4x $ FIXED DOCK (LOT 6) ------- s -U�- v (10 4 4' (LOT 7) F ( ���' ' - I \ FamCM.LvnCN Pe.Y'3>t.iE.,b i 6 !'`i,^„klF '' �I �' � ) O --"v\ vs+G;�,l„r� 'R"�hj^ f'Fys k.:34rr'''~ •'. '�' 6 X4 GG p (FUL U T EX. FLOATING �+" w ^. � n�wl � Mfi 0/ N GES — — -- 9ff `x � r W ¢ N7 wiorH O / DOCK W/RAMP ` ', r _ (.,�, , Q/ Pp ;I (LOT 5) _ , __ `� ��� ii_liv � av f\ Rr= To SEE DETAIL 'A' P.ntl..Po9xrr rti � Q .r y , �N1GHoLS S,IyL TIN (THIS DWC) � (1_8 I 1Ni_ - ------ 7g AXIS / P TING iI ; ; ;i /� o�• _. . .� W., +yxy�.. ,� ,1 � ILES 1 y/i' / � q �'I' _ � ��� ���`"<'�'a,"^•d LIT °+ �r��'�;�'ci"�t" ��' EX. PILESJj s � ` -- ( I � TYPICAL) f�*ae�'�"�'."i '' Y��f'�,�'•+SSS}���� sE� V��-f,,,j;'•- S �•4,di��� �4, , ' ". {/�+LK�IE,gp PROPOSED � ,�, ,; ,.�r .'� �"�'�1 �" ,�'• -, ,�� � �-',<,•,,� �.' -' C� ' NON-TURF BUFFER � � � „�, � ^` � � a �• �•+� �, A.� .� NON Oposeb /5=' 3'�' x � ( � L,op ,a LOCATION MAP: • 'TURP B!lFP�R ' 2(2 O NOT TO SCALE LOT (D YACHT BA51N - .. DHELLIN6 ----- - --- ----------- NSES PUBLIC,HATew 5 — — — �5 � (WIDTH V-350.009 ®� NE 0 _6 NOTES: �F,�y, T.B(/ DETAIL 'A' SCALE= I" = 120'-0° 7� z¢ x I. 51TE: 355 LAKE DRIV , � `KtfCJLD, NTc� 5.G.T.M. 1000-80-03i� e / 2. ELEVATIONS IN N.O. D q) UJ O \ 3. PURPOSE: PRIVATE LL, .�`'J' �e 4. TIMBER TO BE GGA TE SIJ �e \ / 5. DELETED Q� ,� / LOT p 6. WATER DEPTH5 REGOLLJ (J �'b -� \ DiIELLiN& 1. ADJACENT OWNERS. Q / xe,2 LASES PUBLIC,HATER SOF 0.01 BROWN LOAMY PROJECT DISGRIPTION: PROPOSED FIXED DOCK / SAND APPLICANT NAME: STEVE KUBRYK 2 x5 T HOLEY\ 6 5' 2S' CONSULTANT NAME: JEFFERY T. BUTLER, P.E.,P.G. SYMBOL LIST: ���¢, / DATE PREPARED: 10-02-Oq PROPERTY LINE �oy�, 4` 1 ez FENCE ;� jE >E SITE PLAN 74. 4 BROWN FINE ° l` � ` TO COURSE PROPOSED PRIVATE DOGK SANTE-5T HOLE ® � x � ° 355 LAKE DRIVE, BAYV I Elul, NY ` P4 S.G.T.M. 1000-50-03-15 PHOTO KEY HATER BODY: YACHT BASIN NOHATER IN COUNTY OF SUFFOLK TOWN OF SOUTHOLD /NV, rcz�x PALE BROM Ste) y� COURSe AND JEFFREY T. BUTLER, P.E., P.C. O TEST HOLE DATA P.O. BOX 634 SITE PLAN A5 5HONN ON 5HOREHAM, NEM YORK (DATED 03-05-07) TEL.: 631.208.8850 FAX: 631.727.8033 30 15 O 30 60 90 120 150 6RAPHIG SGAI-E I° 30'-0• JOB No. 08005b 10.0 C1.0 - - - - - - - - - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 0 - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - — 1.0 —- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 6.0---- - - - - - - - - - - - - - - - - - - - - 5.0 --- - - - - - - - --- - - - - - - - - - - - - - = - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - --------- . . .... WAN HIC-Ai WATER 2'-b" -:::: ::: 4.0 - - - - - -- -- -- 3.0 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -A- - - --- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -A- . -=.7= - - - - - - - - - - 2.0 - - - - - - - - - - - _ - - - - - _ -_ - - - - - - - - - - - - - - - - - -i- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -i- I MEAN LOW WATER = 0'-q" - - - - - - - - - - - - - - - - - - 01.0 - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - .0 - - - - - - - - - - - - -- - -1.0 BOTTOM EL. -2'-4" BULKHEAD -2.0 5EA15ONAL GROUND WATER IYAGHT E3A51NI -5.0 SEGTION A-A i7SEE DETAIL (THIS PHO) 20 - 10 0 20- 40 60 80 100 GRAPHIC, SGALE 111 201-01' NE N4 T BU cr- PROP05EP FIXED VXK 4'-0' WIDE x 24'-0" LONG p 86.00 50.FT. 73 f LADDER 241-011 T.O.B. = 4D I PROJECT V15CRIPTION: PROPOSED FIXED POCK APPLICANT NAME: STEVE KUBRYK MEAN Hl" WATER = 2'-6" CONSULTANT NAME: JEFFERY T. 13UTLER, PE.F.C. EL. 2,& • • DATE PREPARED: 10-02-0q MEAN LOW WATER O'A" 4 - - - - - - - - - - - - • - • - • - • - - - • - - -_ - - - SITE PLAN USE 4" x 40 SUPPORT @ PROPOSED PRIVATE DOGK 7' DEEP PENETRATION (TYPICAL) 130TTOM EL. -2'-4" 355 LAKE PRIME, BAYVIEN, NY S.G.T.M. 1000-&0-03-15 EXISTIN& 'V HATER BODY: "rAGHT E3A51N 13ULKHEAP COUNT"( OF 5UFFOLK TOM OF 5OUTHOLD DETAIL OF DOCK u 1 11 u SCALE: 1/&" = 1'-0" JEFFREY T. BUTLER, P.E., P.C. PROPOSED FIXED DOCK, P TOTAL SURFACE AREA = q6.0 SO. FT. P.O. BOX 634 241-011 5HOREHAM, NEIN YORK TEL.: 631.205.8850 FAX: 651:127.5033 JOB No. 080056 tg%jFFOt�.cd� -' s Peter Young,Chairman y Town Hall,53095 Main Rd. Lauren Standish,Secretary P.O.Box 1179 Southold,NY 11971 -*A ��' Telephone(631)765-1892 Fax(631)765-6641 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held Wed., July 14, 2010, the following recommendation was made: Moved by Doug Hardy, seconded by Jack McGreevy, it was RESOLVED to SUPPORT the Wetland Permit application of STEVE KUBRYK to construct a 4'X 24' fixed dock attached to the existing bulkhead, 4"X 4" CCA piles with open grate decking on surface. Located: 355 Lake Dr., Southold. SCTM#80-3-15 Inspected by Doug Hardy Vote of Council: Ayes: All Motion Carried MIX I f a t � A� 07/14/2010 12 46 07/14/2010 12 : 47 F osu�Foc�- Jill M.Doherty,Piesident P O Box 1179 James F.King,Vice-President �� Oy Southold,NY 11971 Dave Bergen ti Telephone(631)765-1892 Bob Ghosio,Jr ,y, Fax(631)765-6641 John Bredemeyer tp,y !'F Southold Town Board of Trustees Field Inspedtion/Worksession Report Date/Time: STEVE KUBRYK requests a Wetland Permit to construct a 4'X 24' fixed dock attached to the existing bulkhead, 4"X 4" CCA piles with open grate decking on surface. Located: 355 Lake Dr., Southold. SCTM#80-3-15 Type of area to be impacted: _Saltwater Wetland Freshwater Wetland Sound Bay Distance of proposed work to edge of wetland Part of Town Code.proposed work falls under: _Chapt.275 Chapt. 111 other Type of Application: Wetland _Coastal Erosion _Amendment Administrative_Emergency Pre-Submission Violation Info needed: II l � Modifications:' �J� l ✓� Id":::7 Conditions: eve °G� U ,tel l Present Were: 1­11.Kin J.Dohert J. Bredeme er `"D. Ber en g — Y— Y g — B.Ghosio, D. Dzenkowski other Form filled out in the field by Mailed/Faxed to: Date: '� .lY^i.'�```r s'•v. j''• w , ,p� Ot' If y�l4 ba4� tip � 2�- �•lj y x � � r� '!�•; .f-"lk .v y •. ro Y bk fps �. ...✓ •.F k I��,w IN Oc to } 't rlltr_ 4y,•� t F� S pp '•Y T 1 � _ :3 's c ,. Ak 71, .+11�. Ent, let: 1F a a. ,.� ! �. y, I•. 4 AA ��: Y�� .ry t ,�_�Y J' •� - . j) a, '2 op y, w r � y ` ' a ".r •# : M . ' k wx, �4 frA k a p a � V V t4 w u i r ,J a C ♦. y - t � i � x r u w . 1 f t �r i'p Ml NK a7J f l� �� �f/.�"+, i ♦ Y 8 ar I{ � .�t.. ��(�r t *P �vEfa"h9 t'� I 2 ei, ` fr-.ti'• .`; fy'(1� 4 d1Y'� .S ��1�•. '. �r�A��' f y. ;o i � `e�'�k• Aft'.." 1 i,.l 3 stil/ t�� r' e. z _ Z. y y 1 J 7 f_ sW.a L� i BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO. 6652 DATE: JUNE 20 2007 ISSUED TO: FREDERICK RAPP PROPERTY ADDRESS: 355 LAKE DR., SOUTHOLD SCTM#$0-3-15 AUTHORIZATION } Pursuant to the provisions of Chapter 275 and/or Chapter 111 of the Town Code of the Town of Southold and in accordance with the Resolution of the Board of Trustees adopted at the meeting held on June 20.2007,and in consideration of application fee in the sum of$250.00 paid by Frederick Rahn and subject to the Terms and Conditions as stated in the Resolution,the Southold Town Board of Trustees authorizes and permits the following: w Wetland Permit to construct approx.40 lf, of vinyl bulkhead in place of existing timber bulkhead and backfill with approx. 25 cy. clean sand to be trucked in from an upland source,with the condition of a 15' non-turf buffer landward of the bulkhead, and as depicted on the plans prepared by En-Consultants,Inc. last dated July 5,2007. IN WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, y. and these presents to be subscribed by a majority of the said Board as of this date. � ��yQgU�f01�.�dG +',� vu ,x •>;�•'�+","?�. $�''t:�,n^ ---rte �r�'S?.a` �-f�`.`•'G,� `+•�.'}� ...�, �`�a,� —'.r. c«• I�� �_�.C�":.._�..�._�.-a:" �[r '�L-_=ti's•��. '� .'li �.=..__f�b �,_:�,SC���o.'�"fr^.r/!`iC')� ��`n' \- ;: Trustees Board Of Southold Town SOUTHOLD, NEW YORK' }� PERMIT NO. .. _.3.744.. .... DATE: ..June. 23,, 1989 ISSUED T ..............FRRDB1UCK...R 6. 7. Pursuant to the provisions of Chapter 615 of the Laws of " the State of New fork, 1803;-and Chapter 404 of the Laws of the State of New York 1952• and the Southold Town Ordinance en-titled "REGULATING AWTHE PLACING OF OBSTRUCTIONS ' - Q IN AND ON TOWN WATERS AND PUBLIC LANDS and the U'4 . 'A= REMOVAL.OF SAND, GRAVEL OR OTHER MATERIALS FROM �. LANDS UNDER TOWN WATERS," and in accordance with the t June 22 r ����-"q"•�' �;• Resolution of The Board adopted at a meeting held on .. ... : - ��`°� -;,�`�; 19. 8.9..., and in consideration '9f the sum of $. paid by ........................ ... .. ..... ..........•....•... •--- - - !�a r�! of -•••---•................ . ........ .. .. ........ N. Y. and subject to the I ! Terms -and Conditions Misted on the reverse side hereof, of Southold Town Trustees authorizes and permits the following: To remove and replace 40 lineal ft. bulkhead, dredge N maximum of 10 cu. yards, spoil to be used for -backfill. all'in accordance with the detailed specifications as presented in !°_ ,,;•, js the originating application. ( IN WITNESS WHEREOF, The said Board of Trustees here 1= f _ 'by causes its Corporate Seal to be affixed, and these presents to be subscribed by,a majority of t said Board as of this date. N.,. ,f:�rs�.r s =r,.r%r/--"-,�• x a..a.iss••.rar"!—�.:�'r���-s+'ac.�xr��c�' r..ari�=+t 1.y��y'�.a_r_r-w�,ra�s a^ a- r" �b= i 1 �u; ��^ ��,��„8�� � �s-< ++W7w!..�'�� `'•� � ,,�.0�~� -t'w'z ��,��;-.e '%xY�.��\�;�"? ,.z y.��y�c''ce ��'�_ f SUN WUIty IbRter mrertKO�N 1 L9111 M - U.'`J' N { ^'-'- nm avRn a � lqr vnrn N. P� Q0.!mNR Tl.Y1P 6 GNO®ITFJ 0 0 YIIC N iFFT. _ ' 9---� 171 Ym w,I31A J.°u. _ —_ _ _ �IpfTFIf PWl559f cs,TxE.�; _ ,f-;l i-�--_ - _--.•I;.�m.,<-":.r"a.: ,-1,..v .,==L�_- -_=I� -_ _-_ —�'I"-`�'-��t -_ - -I - - - -.*I" -_ - ---- I.. 4�•" _ - _ - ,_- - _ _ - PROPERTY-NM=- LMu" „ . .- 1..,,.,. eF.n�=;,�:,:�- .._,� .=ss4.,a ..�.:s:'�W=c.-' �..�.a.:...._ 4,.�:..:X � ,, ^�"=a'.<tt-'.T�.""�, ���� �'�•;^�_ -�'v;,:� t'�a _i,'r+a�"�,.�.�z� ;__ �. ,� _y'�'�=a i StiJ- I2 IO 20 06 3 ! 2^2fk1 !13 9[C Nam 1� L!11 3 LAKE DR. a. arr 5—u---- .. .!N \1 121' mI. A '- 2z1 __—_—__ o ._iv_ -- � ---15= fA ®I°°•*� is A\\ w `a_ _ O\fat A 4 \.le 1 \ , I13y \ �\ g II i" zP GROVE \ \ \ 12f•Z �!2II L n..n=o• e w mm — fa.eemn,w -- — F»w.s.u.-- -- x T2i NOTICE COUNTY OF SUFFOLK © E 1°0j6 SOUTHOLD secnDH Ro E 121> .... F.P.M . -- -- -- -- N,NIEx.MF.AIFP,Ta494E0P ,y�,'s ReDI Property Tax Service Agency r G PnP.°r. - e - Irnc Pnrtr P. —_ __ — —_ a91P@Ufal Pi fIR P0R0Y61N: o NJR6 p N f µ--- a la.,ryi.W —_— —_ —_ u.—..—- ums N2UA mNR T. uu 6 PPW&f!D ' Canty I'eMer Poverluo4 K T 11901 M O V 0 Sr ON rw. v �1m um or v u m fe°F...w -- -- rtPan.wn1N Pfb69ai a TIE 4+F u a srxP N{FP, A amn a lODO Pea PPPPcurr T!9 s29mz far¢r P PROPERTY MAP -- rAl',El�i Of14 of f0.ffN J James F.King,President ,of SOUry® Town Hall Jill M. Doherty,Vice-President l0 53095 Route 25 P.O. Box 1179 Peggy A.Dickerson � Southold,New York 11971-0959 Dave Bergen G Bob Ghosio,Jr. a0 Telephone(631) 765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Office Use Only oastal Erosion Permit Application Wetland Permit Application Administrative Permit / _Amendment/Trans r/Ex rasion /Received Application: 9' /C JUN 2 9 2010 Received Fee:$ ° !Completed Application _Incomplete Southhold Town _SEQRA Classification: Board of Trustees Type I Type II Unlisted _Coordinahon:(date sent) �I�VRP Consistency Assss ent Form ' 4,eAC Referral Sent: ate of Inspection: _Receipt of CAC Report! _Lead Agency Determination: Technical Review: _ lie Hearing Held: l Resolution: Name of Applicant 5T& y/L Address 6 )-IA/L eW o �, <foo j,-r �osS6–r, r Phorie Number:( ) 4EiF.-L6 Suffolk County Tax Map Number: 1000 - B-n Property Location: 3 L deee ®2. 'V, (provide LILCO Pole#, distance to cross streets, and location) 7' (If applicable) Address: O�a; 1 N&:C z-jV e A!q A Phone: 08 S0 C �� 'Vv Lrd of Trustees Applicatiir GENERAL DATA Land Area(in square feet): /[ _ 3.-'( ( d �6 4) Area Zoning: —yam Previous use of property: 1/A 1,A�E/T Intended use of property: N6 il�'A/Y1, Covenants and Restrictions: Yes ✓ No If"Yes", please provide copy. 17pES l�'L5 pzoid-� 12, l,. 2e, ,�- ✓AF4,om 7;te zB � � A)U Prior permits/approvals for site improvements: Agency Date SQ ra"o?-, Tip ms s 4' -Zo -- -7 F<f T 66.3-:Z No prior permits/approvals for site improvements. Has any permit/approval ever been revoked or suspended by a governmental agency? ,,--'Ro Yes If yes,provide explanation: Project Description(use attachments if necessary): 6 `iyy//q& --� ag �a a Lo A6 F- O 0 B,,y z.l�fz'��D Dc--o/Z//y- W SLJJL1--/4 Ger, Dze,IL L S �b R-t VA ✓-i Ll,moi 6 Mrd of Trustees Applicatii WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:&L e-�s 77,-P VA G.,z r AA s /x/ Area of wetlands on lot: square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: ;0 feet Closest distance between nearest proposed structure and upland edge of wetlands: _feet Does the project involve excavation or filling? 0_No Yes If yes,how much material will be excavated? cubic yards How much material will be filled? 0 cubic yards Depth of which material will be removed or deposited: feet Proposed slope throughout the area of operations: 6,e,A -r- Manner in which material will be removed or deposited: Al �A 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): AU D ird of Trustees Applicatb COASTAL EROSION APPLICATION DATA Purposes of proposed activity: Alf5lAl Are wetlands present within 100 feet of the proposed activity? No�Yes 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? f (cubic yards) Manner in which material will be removed or deposited: di Describe the nature and extent of the environmental impacts reasonably anticipated resulting from implementation of the project as proposed. (Use attachments if necessary) /U,,A/e- A neTle�iPA ►ard of Trustees AppLicatj I ' i AUTHORIZATION (, here the applicant is not the owner) L /c residing at r (print owner o4f prop rty) (mai ing addre s) tl /1 � + � do hereby authorize (Agent) f to apply for permit(s) from the .I r Southold Board of Town Trustees on my behalf. I (Owner' sign e) I I i f i .i I i I I � i ,l 'I I i I! f 8 PROJECT ID NUMBER 61720 SEQR APPENDIX C STATE ENVIRONMENTAL QUALITY REVIEW SHORT ENVIRONMENTAL ASSESSMENT FORM for UNLISTED ACTIONS Only PART 1 -PROJECT INFORMATION (To be completed by Applicant or Project Sponsor) 1 APPLICANT/SPONSOR 2.PROJECT NAME 3 PROJECT LOCA ION. Municipality Re,, ay')✓ )t'U/�a�5 County SOFr-zszl� 4 PRECISE LOCATION* Street Addess and Road Intersections, Prominent landmarks etc -or provide map 3S s- LA46- lD — 80 — o � 5 IS PROPOSED ACTION. �ew ❑Expansion ❑Modification/alteration 6.DESCRIBE PROJECT BRIEFLY: P12, e0 VS � �q6- X Dy (6 A rl-A e—ArEP � '5�t 15-r'nV' 7.AMOUNT OF LAND AFFECTED- Initially,,9EF-9— acres ,oo-s— Ultimately acres , oo Ste' S.WILL PROPOSED ACTION COMPLY WITH EXISTING ZONING OR OTHER RESTRICTIONS? ©Yes ❑ No If no,describe briefly. 9 WH T IS PRESENT LAND USE IN VICINITY OF PROJECT? (Choose as many as apply.) Residential ❑Industrial ❑Commercial ❑Agriculture ❑Park/Forest/Open Space ❑Other (describe) 10 DOES ACTION INVOLVE A PERMIT APPROVAL, OR FUNDING, NOW OR ULTIMATELY FROM ANY OTHER GOVERNMENTAL AGENCY (Federal, State or Local) ©Yes ❑No If yes, list agency name and permit / approval, N L/s 96z'> 11.DOES ANY ASPECT OF THE ACTION HAVE A CURRENTLY VALID PERMIT OR APPROVAL? F-1 Yes EVo If yes, list agency name and permit / approval- 12. AS A RESULT OF PROPOSED ACTION WILL EXISTING PERMIT/ APPROVAL REQUIRE MODIFICATION? ❑Yes No I CERTIFY THAT THE INFORMATION PROVIDED ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE Applicant / Sponsor Name Date: Signature If the action is a Costal Area,and you are a state agency, complete the Coastal Assessment Form before proceeding with this assessment PANT 11- IMPACT ASSESSMENT(To be completed by Lead Agency) A. DOES ACTION EXCEED ANY TYPE I THRESHOLD IN 6 NYCRR,PART 617.4? If yes,coordinate the review process and use the FULL EAR Yes a No B. WILL ACTION RECEIVE COORDINATED REVIEW AS PROVIDED FOR UNLISTED ACTIONS IN 6 NYCRR,PART 617.6? If No,a negative declaration may be superseded by another involved agency. Yes a No C. COULD ACTION RESULT IN ANY ADVERSE EFFECTS ASSOCIATED WITH THE FOLLOWING:(Answers may be handwritten,ff legible) C1. Existing air quality,surface or groundwater quality or quantity,dolse levels,existing traffic pattern,solid waste production or disposal, potential for erosion,drainage or flooding problems? Explain briefly. No C2.Aesthetic,agricultural,archaeological,historic,or other natural or cultural resources;or community or neighborhood character?Explain briefly: No C3. Vegetation or fauna,fish,shellfish or wildlife species,significant habitats,or threatened or endangered species?Explain briefly: No C4.A community's existing plans or goals as officially adopted,or a change in use or intensity of use of land or other natural resources?Explain briefly: No C5. Growth,subsequent development,or related activities likely to be induced by the proposed action?Explain briefly: No C6. Long term,short tens,cumulative,or other effects not identified in C1-05? Explain briefly: No C7. Other impacts,(incuding changes in use of either quantity or type of energy? Explain briefly: No D. WILL THE PROJECT HAVE AN IMPACT ON THE ENVIRONMENTAL CHARACTERISTICS THAT CAUSED THE ESTABLISHMENT OF A CRITICAL ENVIRONMENTAL AREA(CEAj? If Les,explain briefly: MYes 0 No E. IS THERE,OR IS THERE LIKELY TO BE,CONTROVERSY RELATED TO POTENTIAL ADVERSE ENVIRONMENTAL IMPACTS? If Yes a Iain: Yes a No PART III-DETERMINATION OF SIGNIFICANCE(To be completed by Agency) INSTRUCTIONS; For each adverse effect identified above,determine whether it Is substantial,large,important.orotherwise significant Each effect should be assessed in connection with its(a)setting(i.e.urban or rural);(b)probability of occurring;(c)duration;(d)irreversibility;(e) geographic scope;and(f)magnitude. If necessary,add attachments or reference supporting materials. Ensure that explanations contain sufficient detail to show that all relevant adverse impacts have been identified and adequately addressed. If question d of part ii was checked yes,the determination of significance mustevaluate the potential impact of the proposed action on the environmental characteristics of the CFA. Check this box if you have identified one or more potentially large or significant adverse Impacts which MAY occur.Then proceed directly to the FUL EAF and/or prepare a positive declaration. Check this box if you have determined,based on the information and analysis above and any supporting documentation,that the proposed actio WILL NOT result in any significant adverse environmental impacts AND provide,on attachments as necessary,the reasons supporting thi determination. Board of Trustees Name of Lead Agency Date Jill M. Doherty President nt or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer U-" Signature of RdilibnsIblo Pfficer in Lead Agency Signature of Preparer(if different from responsible officer) t r3oard of Trustees Application County of Suffolk State of New York -X, 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/IH ER 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 f AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE TOWN 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(S), TO ENTER ONTO MY PROPERTY TO INSPECT THE 'PREMISES IN CONJUNCTION WITH REVIEW OF THIS APPLICATION. ignature 01"4�SWORN TO BEFORE ME THIS 2 DAY OP V--"a CY9— ,20_,(V Notary Public ALICIA WALKER NotaryPublicState of New York No.0106153064 Qualified in Suffolk County Commission Expires Sept.25, E f 4 APPLICANT/AGENT/REPRESENTATWE TRANSACTIONAL DISCLOSURE FORM fi The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is 3 necessary to avoid same. G YOUR NAME: rte;t KA (Last name,first name,4iiddle initial,unless u 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 j (If"Other',name the activity.) I a 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 empfloyee 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. •I Name of person employed by they Town of Southold Title or position of that person Describe the relationship betweep 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. c� The town officer or employee orlhis or her spouse,sibling,parent,or child is(check all that apply): b 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,paiffier,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP h G Submitted this of 0_ L Signature Prin e l Form TS I .j Town of Southold _ LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# 8o - -> 3 - 15` PROJECT NAME DAG The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees I. 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: Er Nature and extent of action: 100/-,9 0o5 p 'Yy (� �� -� a 4 �b L b A& Dvim 1= t s )=a x.. 7R-, i-A It !JS e Location of action: S S LA /mak?. Site acreage: - 0161 Present land use: I/A-e-A fV-d" Present zoning classification: R-Y 6 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: S 7-6—t- Le-',f,R (b) Mailing address: 6 141,4,-17o (c) Telephone number:Area Code (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? -Yes ❑ No❑ If yes,which state or federal agency? /V Y:5 DeCi 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//�� ❑ Not Applicable i Attach additional sheets if necessary l I Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See p 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 HI—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No Q Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No 5Not 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 1:1Yes ❑ No u 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. ❑ ❑ Er Yes No Not ApR _xtble Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No[� Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III—Policies; Pages 38 through 46 for evaluation criteria. Ef i Ye�] No❑ Not Applicable r �- Attach additional sheets if necessary s WORKING COAST POLICIP__ Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III-Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Townn waters. See LWRP Section III-Policies; Pages 57 through 62 for evaluation criteria. ElYes ❑ 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 eevaalluation criteria. ElYesElNo OU 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 6-U 37-e-f- , TITLE ee-46, DATE-9-