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HomeMy WebLinkAboutCiravolo, Charles & Gina Glenn Goldsmith,President �QF SO&P Town Hall Annex A.Nicholas Krupski,Vice President ,`O� Ol0 54375 Route 25 P.O. Box 1179 John M.Bredemeyer III Southold,New York 11971 Michael J. Domino y Aw G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 01 C"'UNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD NOTICE OF DISAPPROVAL - ADMINISTRATIVE PERMIT Date of Receipt of Application: June 4, 2021 Applicant: Charles & Gina Ciravolo SCTM#: 1000-52-8-3 Project Location: 2415 Long Creek Drive, Southold Date of Resolution/Issuance: June 16, 2021 Reviewed by: Board of Trustees Project Description: For-a:T.en_(10) Year Maintenance Permit to prune bushes and,trees as needed; and to install railroad tie.steps on sloped area down to beach. Findings: The Board of Trustees DENIES WITHOUT PREJUDICE the application as submitted. The project does not meet the requirements for issuance of an Administrative Permit set forth in Chapter.275 of the Southold Town Code. Applicant did not provide additional specifics as well as updated survey/site plan which were requested after Trustee Field Inspection visit. Any other activity within 100' of the wetland boundary requires a permit from this office. This is not a determination from any other agency. We�' " Glenn Goldsmith, President Board of Trustees z D EC EPVE Charles Ciravolo 12 Darby Dr. JUN 18 2021 South Huntington NY 11746 631 6970750 Southold Town Board of Trustees cciravolo@fmancialguide.com Board of Trustees June 17, 2021 Town of Southold Town Hall Annex 54375 Rt 25 P.O. Box 1179 Southold NY 11971 Dear Southold Trustees, Today I spoke with the assistant town attorney; Damen Hagan who called me to follow up on my letter I sent yesterday. He stated that because the wetlands application had listed two items and that one could not be approved without an updated survey, both were denied. He also indicated that I should resubmit the application with only the tree pruning mentioned. I had a few follow up questions related to this before I submit a new application. 1) Based on your June 8th, 2021 site visit would the board approve the pruning as indicated in the follow up letter attached. The letter was requested from the board on that day and it did not seem as there would be an issue, however, I want to make sure before I resubmit. 2) Because I already paid the $100 fee would I have to pay once again? As this is a follow up and was already indicated on the other application, I do not see why a second fee would be necessary. 3) Would another site visit be required? Please let me know the answers so I can proceed accordingly. Feel free to call or email me back. Charles Ciravolo 631 6970750 SCC 0VE Charles Ciravolo JUN 18 2021 12 Darby Dr. South Huntington NY 11746 Southold Town 631 697 0751 Board of Trustees Board of Trustees June 8, 2021 Town of Southold Town Hall Annex = -5437-5 kt 25 P.,O.,Box 1179 ,Southold NY 11971 Dear Southold-Trustees, ' As a follow up to your site,visit on June S,2021, attached is a detailed list ith, photos'from, arborist; Shamrock Tree Co. for the tree pruning that we would lik to , get,approual for.You mentioned you wanted this prior by Monday, June 14"to be,- added e,added to the list for this month's meeting. Please let me know if you,have axiy . questions'. Tk you ' Charles Ciravolo . E t SHAMROCK TREE CO. Date Scheduled: P.O. BOX 1472 ® MATTITUCK, N.Y. 11952 631.298.2175 Date Completed: Inspected by: Estimate for: -1 `l 0Deposit Check ff: Street: 1' -- �--r"� '`'' flint: Date: City,State,Zip: Balance Check#: Phone: Amt:. Date: Work to be Performed: P1�t Ve-- t 0 w e_-r I V4 timet . G $ t l i t '' iNt 6J . Shamrock Tree Co.is not responsible for any damage done to sprinkler systems,wiring or other underground utilities while grinding stumps. Cost of Services .................................... $ �O + Sales Tax....................... ! . . .. $ Tota] ...................................................... $ 10% Deposit Due on Approval ............ $ Balance Due at Completion .................. $ DA Submitted by Date Accepted by Date ,l 1 d ! is K r . k a •:pix p C'. «p t e p '� i rr !.' �t <: 'alp s'�j �,.� i ♦ •la '.« y� aR. c'' F'd w .r Y-�_ � R; '�.r' ����"�.�i4r' }yam/' �C#`•• >�d' �" .ii A a d '# t V'�-' ws �'.� a It 41 ow In .4s'`" , u ,t"• t, V , .�R s �, N •ak � � � ,air xy+' �',` -•� 'S � ^*� ''// = ,'�"�,• '�� E'•l!� h 5'� 4 t� w All - - � .. v ,fir €- ¢ a �. ` ,, aoo . 15 lum 14 rs DiSalvo, Diane From: Ciravolo, Charles <cciravolo@financialguide corn> Sent: Thursday,June 17, 2021 4:55 PM To: DiSalvo, Diane Subject: Assistant town attorney Attachments: follow up letter 06-17-2021.docx;Tree Pruning 2021.pdf Please forward to the board. Regards, Charles T. Ciravolo, LUTCF, CLTC To request an appointment click below: Financial Advisor, Financial Planner https://catend[y.com/ciravoto 6800 Jericho Tpke. Suite 202 West Syosset, NY 11791 Office: (516)682-3320 Fax: (516) 364-4263 Mobile:(631) 697-0750 www.cwpmetro.coin Don't keep me a secret, please let others know how I can help them! Insurance Representative of Massachusetts Mutual Life Insurance Company(MassMutual)and affiliates M Springfield MA 01111-0001 Registered Principle of and securities products,investment advisory and financial planning services offered through MML Investors Services,LLC a MassMutual subsidiary*Member SIPC (www sipc ora)Supervisory Office 6800 Jericho Turnpike Suite 202W Syosset NY 11791 (516)364-4203 Center for Wealth Preservation,Gary Ranftle,General Agent d-lwp Lite,,or t'let:rth lir seruzzti n o MossMutuol firm This e-mail transmission may contain information that is proprietary,privileged and/or confidential and is intended exclusively for the person(s) to whom it is addressed. Any use, copying, retention or disclosure by any person other than the intended recipient or the intended recipient's designees is strictly prohibited. If you are not the intended recipient or their designee, please notify the sender immediately by return e-mail and delete all copies. > DiSalvo, Diane From: Ciravolo, Charles <cciravolo@financialguide.com> Sent: Wednesday,June 16, 2021 9:55 PM To: DiSalvo, Diane Subject: FW: 2415 Long Creek Dr. Southold NY Attachments: Southold letter 6-16-2021.docx; Southold steps .docx;Tree Pruning 2021.pdf Please see attached and forward to the board. D E C E � V E Thank you, I JUN l 7 2021 Charles T. Ciravolo Southold Town 631 697 0750 Board of Trustees This e-mail transmission may contain information that is proprietary,privileged and/or confidential and is intended exclusively for the person(s) to whom it is addressed. Any use, copying, retention or disclosure by any person other than the intended recipient or the intended recipient's designees is strictly prohibited. If you are not the intended recipient or their designee, please notify the sender immediately by return e-mail and delete all copies. Registered Representative of and securities offered through MML Investors Services, LLC, Member SIPC and a MassMutual subsidiary. Transactions may not be accepted by e-mail, fax, or voicemail 1 Charles Ciravolo 12 Darby Dr. South Huntington NY 11746 631 697 0750 cciravolo@financialguide.com Re: 2415 Long Creek Dr, Southold NY Board of Trustees June 16, 2021 Town of Southold Town Hall Annex 54375 Rt 25 P.O. Box 1179 Southold NY 11971 Dear Southold Trustees, When you came to our home for a site visit on June 81h' 2021 regarding the wetland application for tree pruning as well as the placement of steps, you indicated that for the tree pruning we should submit a detailed description along with photos. I sent this to you on June 8th, 2021, see attached. I also sent you a separate letter on June l lth regarding the steps, see attached. These are 2 separate issues and requests, yet at the board meeting, on June 16th, 2021 the board denied both stating that I refused to provide a new survey. Regarding the trees, I still am requesting the approval to prune them as described in the letter and dated June 8th, 2021. Based on the site visit it did not seem as this would be an issue and they should be treated as a separate request from the steps. Regarding the steps, I need further guidance as to why a new survey is needed indicating where the steps would be. I want to be sure that a survey is absolutely required for the placement of railroad ties to create steps. Or, would you have any other suggestion as to the material or steps that may not need a new survey? Our goal is to provide better and safer access to the beach area. I appreciate your response to both requests. Sincerely, Charles and Gina Ciravolo Lf Glenn GoIk�Y^'th, President O�UFFfI > - Town Hall Annex O`' A. Nicti�;ra.1 Krupski, Vice-President ,�� 54375:Route 25 John M. Bredemeyer, III y P.O. Box-1179 Michael J. Domino o Z Southold, NY 11971 Greg Williams A O� Telephone (631) 765-1892 ��l Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: 6 2s Completed in field by: CHARLES & GINA CIRAVOLO request an Administrative Permit for a Ten (10) Year maintenance permit to prune bushes and trees as needed; install railroad tie steps on sloped area down to beach. Located: 2415 Long Creek Drive, Southold. SCTM#: 1000-52-8-3 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=4 Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet- 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative 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: Ir a�- I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J. Bredemeyer M. Domino /G. Goldsmith Q-,�N. Krupski ✓ G. Williams Other v SHAMROCK E C . P.O:BOX 1472 s MATTI'T`UCK,N.Y. 11952 Date Scheduled: _ - 631.295.2175 Date Completed: Inspected by: Estimate for: C; 70-V 01 t? De osit-Check':' 1� r n �,r' 1 . ' Amt: Date---, ` $treet: :. Citi;Mate,Zip: cr- ° ,'B .lance Check#:. - IS t Amit: " tir ,;x�i be Perf6i•med: L j- v . ' ' Vf 6J U 11 ,. Southold Town Board of.. Shamrock Tree Co.is it© responsible for any damage done to sprinkler systems,wiring or other underground utilities while grinding stumps. Cost of Services .................................... $ �� Sales Tax....................... $ Total ...................................................... $ 10%r, Deposit Due on Approval ............ $ Balance Due at Completion .................. $ i Submitted by Date Accepted by Date is L .1 ✓ gyp" e _ ��,. AWL %a c N4" y� D E C E I V E . .I. 401 lilttpa ,� rya ON sit # tK as r'�r" q�t Vii'+�._ may, 4�„ � '�"` }e �x' :,-� _.,• "^y"'� �' 'tl q �, " �� ,,.ter,. � x ��; .ter►��:r r�� ..+••!:'t.' 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PECO=aC LANO7RU6T '. _� �"f' EFEF GrvO , •.,• � cOft PLUG 'Q :,w:cia o / ,. sec sec no cw sre s;c noaw a -- -- - COUNTY OF SUFFOLK© r TGE = wasa__ —_ '•--.5m°-w._-- <-.,.••.,•• -- m , >_..,`y...,.... . enx•w,. ,area A w=noua .o ano U v 52 D — lal op<=tyax ece Kncy =n 1.—rn Charles Ciravolo 12 Darby Dr. South Huntington NY 11746 631 697 0751 cciravolokfmancialguide.com Board of Trustees June 11, 2021 Town of Southold Town Hall Annex 54375 Rt 25 P.O. Box 1179 Southold NY 11971 Dear Southold Trustees, As a follow up to your site visit on Tuesday, June 8th 2021, regarding the steps referenced in the wetlands application dated June 1St 2021, you had indicated that you needed an updated survey showing the exact placement of the steps. However, in reading the wetlands request form it makes no mention to identify on the survey the exact location. I contacted the surveyor and to have this done it would cost me $1,500. Because of this, I am requesting the board to approve the steps based on the to-scall drawing and the survey where I indicated the approximate placement of the steps. This was submitted along with the application and the board reviewed the placement at the site visit. Based on this please do all you can to grant the approval and request to forward to the town. Please understand I feel it is important to have steps for the safety of myself and my family and to incur additional cost for a survey would not be feasible at this time. And it will not be required. Thank you for your consideration in this matter. Sincerely, D E WE Charles and Gina Ciravolo JUN 14 20 i Southold Town 4 SoOrd 2f W"'PS�_. Charles Ciravolo J U N - 8 2021 12 Darby fir. South Huntin on NY 11746 Southold Town Boar_�f Trustees 631 697 0751 Board of Trustees ,lune 8, 2021 q Town of.Southold Town Hall hex - . 54375 Rt 2-5 =. P.10. Boy`1-179 Southold NY 11911 near.Southold,Trustees, As-a.follaw up to your site visit`on June.8,2021, attached is�a detailed,list with" photos,from,arborist; Shamrock Tree Co. for the tree pruning that we woujd Jik�;to get.approval for. You--mentionedyou-wanted this prior by Monday,June_4 `to be , added to.the list for this month's meeting.Please let me knowif 'o�ha�e4n x g• y . questions. j(( Th yo 3: ry � , e x ./`yV '; Charles Cirav616 ` f OFFICE LOCATION: ®F s® y® MAILING ADDRESS: Town Hall Annex o`® lQ P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) Southold,NY 11971 G ® Q Telephone: 631 765-1938 a LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, Assistant Town Planning Director LWRP Coordinator Date: June 9, 2021 Re: Local Waterfront Coastal Consistency Review for CHARLES & GINA CIRAVOLO SCTM# 1000-52-8-3 CHARLES & GINA CIRAVOLO request an Administrative Permit for a Ten (10) Year maintenance permit to prune bushes and trees as needed; install railroad tie steps on sloped area down to beach. Located: 2415 Long Creek Drive, Southold. SCTM#° 1000-52-8-3 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. , 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,Presidente� Town Hall Annex Michael J.Domino,Vice-President r '� 54375 Route 25 P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 A.Nicholas Krupski Telephone(631) 765-1892 . Greg Williams 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 JUN e 4 2021 Amendment/Transfer/Extension Received Application: C,y Z1 Received Fee: $ No 4So�Town Completed Application: Boards of Trustees Incomplete: SEQRA Classification: Type I Type Il Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: __ACoordination:(date sent): LWRP Consistency Assessment Form Sent: DZAC Referral Sent: Date of Inspection: g'2 Receipt of CAC Report: Technical Review: Public Hearing Held: • l Resolution: Owner(s)Legal Name of Property(as shown on Deed): CAar J'F'r fi �n G C ✓'a VO/b Mailing Address: 1 Ci VON /V Phone Number: (6,7 J / L y o 7�—c) Suffolk County Tax Map Number: 1000 - /YProperty Location: � ®� t`� 9117 `1yyAt /V (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Board of Trustees Applic ion GENERAL DATA Land Area(in square feet): 1 `� Area Zoning: Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes r,/ No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes J 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/ y demolition as per Town Code or as determined by the Building Dept.? _Yes V 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. Has any permit/approval ever been revoked or suspended by a governmental agency? "IX No `--- Yes If yes,provide explanation: Project Description(use attachments if necessary): /0 CCA✓ i1�'',L f rune- treei c,-s ru 1 L r) ®a2 ti S 0, S101C Z 0t!Pg, ��Pf� V16 head . Board of Trustees Applic ion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: ftvmp— b`,j4a w lleal d r Q .5b)rJ 4a4 Area of wetlands on lot: `00 square feet Percent coverage of lot: . P 0 Closest distance between nearest existing structure and upland edge of wetlands: 00 feet Closest distance between nearest proposed structure and upland edge of wetlands: IV/04 feet 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: [VIA A 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): /V/A- 617.20 Appendix B Short Environmental Assessment Form Instr€ ctimmfor Completing Part I -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 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 I -Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): 1._�T C So //L)y Brief Description of Proposed Action; Name of Applicant or Sponsor: (1 Telephone: �,f C&kd e) lj i-k CirCWW-� E-Mail: k,,�le, C ufav�l� u� Address: 06 Ta �G� �� s� wjn ?y� City/PO: IState: 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 El- a may be affected in the municipality and proceed to Part 2. If no,continue to question 2. '2. Does the proposed action require a permit,approval or funding from any other governmental Agency? NO YES If Yes,list agency(s)name and permit or approval: 3.a.Total acreage of the site of the proposed action? ��acres b.Total acreage to be physically disturbed? 0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? D acres 4. Check all land uses that occur on,adjoining and near the proposed action. , E]Urban [3 Rural(non-agriculture) ❑Industrial ❑Commercial Lf Residential(suburban) ❑Forest ❑Agriculture ❑Aquatic []Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, NO YES NIA a. A permitted use under the zoning regulations? ❑ ❑ ❑ b.Consistent with the adopted comprehensive plan? ❑ ❑ Q 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 12 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: El 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? 1711 EL c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? F] 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: 1-1 Q 10. Will the proposed action connect to an existing public/private water supply? NO YES If No,describe method for providing potable water: ❑ I I*.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? � ❑ b.Is the proposed action located in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,or lands adjoining the proposed action,contain NO YES wetlands or other waterbodies regulated by a federal,state or local agency? F " (J( b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? UU II�Ii F71- If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Ideptify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline El Forest ❑Agricultural/grass lands El 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? �ll��- ❑ gVEES 16.Is the project site located in the 100 year flood plain? NO 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 ❑YES in ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: F-1 NO []YES 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: Er F] 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: a 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: F] I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicantisponsor na fir' - ur�v�� Date: � ],?71)0)1 Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? Q 3. Will the proposed action impair the character or quality of the existing community? 11/ U 4. Will the proposed action have an impact on the environmental characteristics that caused the establishment of a Critical Environmental Area(CEA)? LJ 5. Will the proposed action result in an adverse change in the existing level of traffic or ( Q affect existing infrastructure for mass transit,biking or walkway? �j 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate I-1 reasonably available energy conservation or renewable energy opportunities? �( 7. Will the proposed action impact existing: a.public/private water supplies? b.public/private wastewater treatment utilities? 8. Will the proposed action impair the character or quality of important historic,archaeological, (—` architectural or aesthetic resources? E] 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, (—] waterbodies,groundwater,air quality,flora and fauna)? F 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. ® 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 ` Board of Trustees Applic' ' ion 07- ® 7,fo cAIlir AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN 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. Signature of Property Owner igna ure of Property Owner nth � r � � SWORN TO BEFORE ME THIS DAY OF ,,20 a I WbA-NIC t+*W,Fy public,Stat� o'I�awi Y o lc ,4 0 Nt4868UT' Que .Qqunty'; < Notaiy Public APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE.FORM The Ethics prohibits conflicts of interest on the v -Qf Sou old' �LadcolttL _vA offi.Mrs and employ The `u se of this fhrm is to provide inforinatiori which can alert the town of possible'conflicts of interve-iind allow into takewhatever action is necessary to,avoid same YOUR NAME: t-it a;14 CA 161 C� (Last name,first name,"riddle 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 Otherk-110 e4c-,c *4 /--.k I C/CL/ (If"Other'',name the activity.) /0 Leo,- l'11 c` �p - 1h, 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 interesf',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-1 — 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); the legal orbeneficial 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 the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this,� day of 20 A0 021 -I- Signature(:��, Print Name 014"Lefev Form TS 1 Town of Southold LWRP CONSISTENCE'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 sipnficant 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- §gRportimg_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 ANIS PROPOSED ACTION SCTM# - PROJECT NAME C-1('Q VD/<3 k''` "© The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Rept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval,license,certification: Nature and extent of action: :/o k/4 e'!n �,.d :. tYst Pn CCe J - ✓�t ���&� ��I�P�✓, Location of action: J O C d eel— / , S O A !L 1VY) ?0 Site acreage: Z, Present land use: Pe Sd _,(,i;J A)M,-- Present zoning classification: ggi r J 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: C�r,r✓ e C7 ',k y 1Vr.vJ Lv (b) Mailing address: so VA yon V-,nn (c) Telephone number: Area Code ( ) (6,3102- 62S—b (d) Application number, if any: f1,/11 A Will the action- / be directly undertaken,require funding,or approval by a state or federal agency? Yes ❑ No U 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 l.. ]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 LVVRP Section III—Policies; Page 2 for evaluation criteria. ffYes F] NoNot Applicable r em,h v, a 14' S kllz �v rte -- b eac z- of ee, 6A -ehAr. Lc w h'1 c.k e lJ J 0 �� C it hZLA ril.ra r-edyez eo-oritA 0-f L&tk . 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 ff 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 E—Yes ❑ No ❑ Not Applicable C resp (F c,(,e-1 -2� �� 7'o d 0k)-- Cees c�,, /norms a cc.e,.rs 6 cCPQ 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 1:11.40 ❑ Not Applicable ` d3 C«�l ' —« �— v�i2 60"ems �:^ctri C/\. -JfApg—'�— Attach additional sheets if necessary Policy S. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria F] Yes D No allot 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. 1� ❑ ET Yes No -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 F] 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. dYes ❑ 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. F] WE] No� Applicable Nof pplacable Attach additional sheets if necessary WOI TUNNG COAST POLAuiES 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 2Not 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. El Yes F] � No �1 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 ff Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development of energy and mineral resources. See LVVRP Section III—Policies; Pages 65 through 68 for evaluation criteria. ❑ Yes ❑ No Q Not Applicable PREPARED BY J111"le, �f ✓a.�J TITLE_ ��®�`''� DATE b � �S�-/