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HomeMy WebLinkAboutTR-9937A Glenn Goldsmith,President *QF SO(/Jy 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 G • Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1846C Date: August 9, 2021 THIS CERTIFIES that the installation of five (5) 10"x3.5" aluminum signs on the perimeter of property stating: "Private Property'. Signs are to be located along_right-of-wav and beach; At 2445 Nassau Point Road, Cutchogue Suffolk County Tax Map#1000-104-13-6 Conforms to•the application for a Trustees Permit heretofore filed in this office Dated June 17, 2021 pursuant to which Trustees Administrative Permit#9937A Dated July 14, 2021,was issued and conforms to all the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the installation of five (5) 10"x3.5"aluminum signs on the perimeter of property stating: Private Propertigns are to be located along right-of-way and beach. The certificate is issued to Justin&Elizabeth Mirro owners of the aforesaid P Perms ` Authorized Signature Glenn Goldsmith,President *Qf SO(/rTown Hall Annex A. Nicholas Krupski,Vice President ��Vv ��� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J.Domino N ,r G Q Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 COUNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: LLqz( INSPECTED BY: V Ch. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale-line/silt, boom/silt curtain 1St day of construction % constructed Project complete, compliance inspection COMMENTS: �p ✓I ( � ��s �V` � ?�° CERTIFICATE OF COMPLIANCE: Glenn Goldsmith, President 0 Town Hall Annex A. Nicholas Krupski,Vice President r 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino Telephone(631) 765-1892 Greg Williams ** Fax(631) 765-6641 00(f , 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 HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre-construction,'hay bale line/silt boom/silt curtain 1St day of construction '/ constructed When project complete, call for compliance inspection; Glenn Goldsmith, President Town Hall Annex A. Nicholas Krupski,Vice President54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold, New York 11971 Michael J. Domino Telephone(631) 765-1892 Greg Williams a x Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9937A Date of Receipt of Application: June 17, 2021 Applicant: Justin & Elizabeth Mirro SCTM#: 1000-104-13-6 Project Location: 2455 Nassau Point Road, Cutchogue Date of Resolution/Issuance: July 14, 2021 Date of Expiration: July 14, 2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Erect six (6) 10"x3.5" aluminum signs on the perimeter of property stating: "Private Property". Signs are to be located along right-of-way and beach. 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 Justin Mirro, received on June 17, 2021, and stamped approved on July 14, 2021. Special Conditions: Removal of sign #1 as depicted on approved plan and that all five (5) signs are to be no further seaward than the bulkhead. Inspections: Final Inspection,. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. Glenn Goldsmith, President Board of Trustees APPROVED BY B ARD OF TRUSTEES O—N O F S _ UTHQ 'Ib `—«, gJ.mm Al GEAPI PA_, P.— Cub , - v 'TP l le 333.84 �°° $� '•� a NSU'41 €.x - _ Caw i ssroa+ Area= 55,671 sq.ft. o .� g_H.9 - 1 .28 acres �- d 3o5.76' SOUTH BAYVIFW ROAD Final Survey of Lots 7 & 8 L9ND -,(-RVEI7LVG 0 (A Amended Vop A of Mj3s a Poml -- Mintoville@aol.com FILED Alqua IG 1922 FILE NO Iso Fr F 00 sluale of Nassau Point GRAPHIC SCALE C ma Town Of Southold JOHN, MINT0 L5 .E,�R - ,. :uffolk County, New York . _.1 93 SAIMITOBW DOULEI;9RD SAIMIT011W. NTax Map #1001--104-13-6 Y. 11787 ( IN FEET - I inch — 40 et gale 1"= 40' March 1 , 2021 Glenn Goldsr}lel, President �o�aoffo(i111 ,Town Hall Annex A. Nichola6 rxrupski, Vice-President ,� `�-�, 54375 Route 25 John M. Bredemeyer, III o ` P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams y ®� Telephone (631) 765-1892 ��l Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: (c ��I Completed in field by: N JUSTIN & ELIZABETH MIRRO request an Administrative Permit to erect six (6) 10"x3.5" aluminum signs on the perimeter of property stating: "Private Property". Signs are to be located along right-of- way and beach. Located: 2455 Nassau Point Road, Cutchogue. SCTM#: 1000-104-13-6 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 v Ch. 111 SEQRA Type: I II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 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: �o C�sc�)ss-,rk � I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other UNAUTHORIZED ALTERATION OR ADDITION Property also known a and designated os TQ THIS SURVEY IS A VIOLATION OF lot 7 and the northerly 75 feet of lot 8. I° � JM SEC 710N 7209 OF THE NEW YQRk STATE "Ma of Pro d Subdivision, Section A. tyN V A JMM EDUCATION LAW. p pase L CPIES OF THIS SURVEY MAP NOT BEARING Nassau Point Club Properties, Inc.' 0'7 \ , ao rh[art. MARCH 1071 ,HE LAND SURVEYOR'S INKED SEAL OR ,THE SEAL SHALL NOT BE CONSIDERED h. IIS ""'u - ' Ip_ Nassau Pohl AsbuiIt TO BE A VALID TRUE COPY. 6011 LIAR ANTEES INDICATED HEREON SHALL RUN iNLY TO THE PERSON FOR WHOM THE SURVE' 39-IW c Nra�N,p ats `7 '.nN IS PREPARED, AND ON HIS BEHALF TO THE - p8'N TITLE COMPANY, GOVERNMENTAL AGENCY AND ' M 1T"01 o LK J LENDING INSTITUTION LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTI- 011 TUT ON GUARANTEES ARE NOT TRANSFERABLE. \\ Mm N80a42'0 Note: ALL SUBSURFACE STRUCTURES; = - WATER SUPPL16 'r, SANITARY SYSTEMS, ,pmi�' - -- / 775 P'R,iyq DRAINAGE, DRYWELLS AND UTILITIES. ��'°��� p7p50NK1 epW'9 A- --�-------- -- ARE FROM FIELD OBSERVATIONS _>� BUIlDIN6 bw+-- b b*eK �wx gg AND OR DATA OBTAINED FROM OTHERS THE EXISTENCE OF RIGHTS OF WAti 403 AND/OR EASEMENTS OF RECORD IF AN,. NOT SHOWN ARE NOT GUARANTEED. Premises known os _��p # 2455 Nassau Point Road Lot .; i°yynm vO va- tll- 6' N pome 2900 Nr ' s Area= f--- - c 55,671 sq.ft. o o $ MaN 1 .28 acres _.bP6 - r' ru OtiN hhLLff doo,,goVIN k ii o:Ex 305.76' TO BAY 0 ROAD Final Surveyof SOU Ica ' rel Lots 7 & 8 LAND SURVEYINGU1 C SIE Nu, a Iuli J Mintoville@aol.com D C Z FILED Auqusf 16 IQ'' FILE N0. 156 SVBDI VISONS ' S Sit,, TITLE & MORTGAGE SURVEYS -.O TOPOGRAPHIC SURVEIS _l Nassau Point LAND PLANNERS --4O SITE PLANS �' GRAPHIC SC aLE O own ui Southold rlIA ,t1N"PO. L.S. PHONE- (631) 724_48 i- 20 <a 90 , C=1 offol� County, New Yoi I' i L L<Nn�Suev6+oR 11 NO. _866 FAv / -Sys= - t� T Z G 93 .WITHTOWN BOULEVARD SMITHTOII IN FEET I, Tax Map #1001-104--13-6 ( ) 1 Inch = 40 ft. V cale 1"= 40' March 1, 2021 UNAUTHORIZED ALTERATION OR ADDITION Property also known as and designated as TO THIS SURVEY IS A VIOLATION OF lot 7 and the northerly 75 feet of lot 8, 1e•erd MW gr JMM CHEOG er JM SECTION 7209 OF THE NEW YORK STATE 2SN EDUCATION LAW. "Map of Proposed Subdivision, Section A, � ls COPIES OF THIS SURVEY MAP NOT BEARING Nassau Point Club Properties, Inc." wall end a GpsttfatE MARCH 2021� 0.3'N THE LAND SURVEYOR'S INKED SEAL OR EMBOSSED SEAL SHALL NOT BE CONSIDERED e.end ^0n" 2'6N pyt Nassau Point Asbuilt TO BE A VALID TRUE COPY. t tenu 1 t N Lot 6 , 6.0'N ° o9'N o_ai°" o-° 116 0.8'5 a GUARANTEES INDICATED HEREON SHALL RUN 333.84 fence end 0.4'S talk ONLY TO THE PERSON FOR WHOM THE SURVEY pool toll end n IS PREPARED, AND ON HIS BEHALF TO THE TITLE COMPANY, GOVERNMENTAL AGENCY AND egu,pmenl 0 1,.80 0.8'N utility o steps 10.11 '�_ LENDING INSTITUTION LISTED HEREON, AND P^e ° I ®1076 ,1'88 ShoMe TO THE ASSIGNEES OF THE LENDING INSTI- NgQ°42'OQ°� ° ° tence°^9k� fCe 03, fence walk landing� TUTION. GUARANTEES ARE NOT TRANSFERABLE. 1. fence _ 3 cal u,,0.5'N 1.B S ry (( 11 Note: ALL SUBSURFACE STRUCTURES; 21.56 chain link fence !819 rdlti ,43�00* f planters \\���// 1L6? 1 51.6, WATER SUPPLY, SANITARY SYSTEMS, x p \_fence end ao ____ o // roof ^9 DRAINAGE, DRYWELLS AND UTILITIES, 19.11 ub�h 0.4'5 'ae rat 1511 \MpgpNR1'<,4.67 --- -� stepping stone N0 - ova 1.75 ro SHOWN ARE FROM FIELD OBSERVATIONS p°� 1874 1151 ® g�IlDING\ �> ----``-- "- drain b*" comms 11.841 1,•15 �.' wff deckI 1183 AND OR DATA OBTAINED FROM OTHERS. 6.31 fuel tank ,N5 1319 !/^ ■o.73 drain11.69 ' ° ``1 -----__"��P°t0�` pt H � 1146 bdor 9 13.72 /;% R draaK40 1942 % l� CJ7 THE EXISTENCE OF RIGHTS OF WAY 120 40.2' 'alk ° V AND/OR EASEMENTS OF RECORD IF fan t,b5 tt 19 ANY, NOT SHOWN ARE NOT GUARANTEED. S n x13.91 drain drain 1�0 1'I/ x11.54 13'14 1,.80 patio 11.59 1194 �p = 11.59 � � 11.81 � Premises known as: 7 11.97 `'' 4.2' caiu^^s IN-6R0�� 1 1.15 columns hot F < # 2455 Nassau Point Road Z 1.6tub POOL 2 column 1��yo1.2 11.84No 11.19 a v� �,�r walk ENCS 1434 column 12.13 pR !2� RESIU 54.8' Z wbbksl°ne cwb^9 2.1 ff-14.1 1.5' Area= C mobu,9 ,2.64 colu^x,s \ masonry patio ,1,82 cabn,estane �. aW°^ 12.22 1.5' Al 11b1 planter walk 3.8' I1-24 a TA 55,671 s .ft. Q 1211 stone aa� _ o o 4 steps x,Ob4 Z x,049 9145 Q ��� x tOb1 7.75 1 .28 acres -�► column Lot U �=11.9 drain 1!'N � x 1159 ®796 roll car• drain 01'N Q _ i1.36retaining wall drain ®190 roll 20Sframe 1057 5.49 steps frame retain..9 (I_ X13.19 68fi s x 8.52 6.14 x roll ca. 3'N 0 - - uW roll end 0.2'N-7 58Q°4ZOQ 916 J fro I i ! o JU N 1 7 2021 t - column ca. frame retaining rail L 1.3'E 305.76 3 x 12 tall 0.3'N Southold Town 1�� t299x Board of Trustees x ROAD NO NE�y �- BAYV�EV� JOHN �To Final Survey of Lots 7 & 8 A LAND SURVEYING f- --- 'Amended Map A of Nassau Point" Mintoville aol.com �-��� FILED August 16, 1922 FILE N0. 156 S� 49666 �J situate at SUBDIVISIONS TITLE MORTGAGE SURVEYS Nassau Point TOPOGRAPHIC SURVEYS LAND PLANNERS SITE PLANS GRAPHIC SCALE Town of Southold D 20 40 80 160 Suffolk County, New York JOHN MINTO, L.S. PHONE: (631) 724-4832 LICENSED PROFESSIONAL LAND SURVEYOR FAX: (631) 724-5455 NEW YORK STATE LIC. NO. 49866 Tax Map #1001 - 104- 13-6 93 SMITHTOWN BOULEVARD SMITHTOWN, N.Y. 11 787 ( IN FEET ) Scale 1 "= 4.0' March 1 , 2021 1 inch = 40 ft. cssMALI PRIVATE PR PERT y NO TRESPASSING mmm� 6/11/2021 Amazon, - :Bagstar Private Property Sign(2 Pack),Aluminur; -,trespassing Sign for House, 10"x 3.5"Metal No Trespassing Signs... Deliver to Justin Garden&Outdoor- \ -ielie.u.+ir ,tehm+s 0 Great Neck 11021 - Account&Lists. &Orders Cart All Buy Again Brma sing History- Smart Home Hone Improvement New 2eleases Outdooi Recreation Amazon Business- Sports&Fitness Fresn- Wriole Foods Livestreams Amazo^Basics Amazon Home Shop by Room Discover Shop by Style Home Decor Furniture Kitchen&Dining Bed&Bath Garden&Outdoor Home Improvement -7 777277 Patio,Lawn&Garden A Outdoor Decor,Yard Signs Last purchased Jun 10,2021. 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". tee>e> ru \ Mso-ro "te9 a OMIS ei,astr .,eM1 ,d, \s '� " aw iw 1E1 s.oWcmmr`�� ,® ai 1` awvsdul ' e` +}♦e`e 1e" ,qa �� ,�, ` �. BROADWATERS COVE \ iX k ,, a.a }� Py' ,0'8 Ee $" `° `°:U, 1�' TOWN OF SOUTHOLD 509 iN m , z:iyc) w o ? 9 \ � a`�-I.yjlR - - ' � 0.t �9, � '"fie,•�- � �'\�^� '. HAYWATER COVE a 13 10 r\ ? at K SECTION NO �.~�.,,..,.... r ewer r__ _ m+..a NOTICE COUNTY OF SUFFOLK C souT99o�o Z1 c —�— (Y) — -- -- Real Property Tax Service Agency v 104 N PROPERTY MAP OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971 Zl� Telephone: 631 765-1938� `"`� �,�p° p 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: July 9, 2021 Re: Local Waterfront Coastal Consistency Review for JUSTIN & ELIZABETH MIRRO SCTM# 1000-104-13-6 JUSTIN & ELIZABETH MIRRO request an Administrative Permit to erect six (6) 10"x3.5" aluminum signs on the perimeter of property stating: "Private Property". Signs are to be located along right- of-way and beach. Located: 2455 Nassau Point Road, Cutchogue. SCTM#: 1000-104-13-6 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 determination that the proposed action is EXEMPT from LWRP review. 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 r� J t Glenn Goldsmith,President �o�soUr� Town Hall Annex A.Nicholas Krupski,Vice President ��? ��© 54375 Route 25 P.O.Box 1179 John M. Bredemeyer IH l Southold,New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams ` Y® Fax(631) 765-6641 coum BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application :zt;Wetland Permit Application rn dministrative Permit Amendment/Transfer/Extension J U N 17 2021 Received Application: 417 A Received Fee: $ 1610.0!6 Completed Application: •Z Southold Town Incomplete: Board of Trustees SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: ---,ZCoordination:(date sent): LWRP Consistency Assessment Form Sent: CAC Referral Sent: -Date of Inspection: 7.7 ZI Receipt of CAC Report: Technical Review: Public Hearing Held: UP 7-! Resolution: Owner(s)Legal Name of Property(as shown on Deed): �Yv5Ttr4 CL%ZA,-j,cTH- Mailing Address: 3 C)R E&A'0-2 F C-T 6'R&-T Al ,C G-N y 1/02-/ Phone Number: 6 6((o- 3 2r Z - S j S _3 Suffolk County Tax Map Number: 1000- 10 y— 13— G Property Location: Z4 SS AIA-SSA;tJ P i 2 t� , Lu Tc H 060E 9 n!'Y I ( Q 3S— (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: Email: Board of Trustees Appli, ,ion GENERAL DATA Land Area(in square feet): 6 `? Area Zoning: taEnrrr A t-- Previous use of property: R&Si c>,c"i(A L Intended use of property: 6%`�L'^l` t- Covenants and Restrictions on property? Yes No If"Yes", please provide a copy. Will this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes No Does the structure (s) on property have a valid Certificate of Occupancy? 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? /V No Yes If yes,provide explanation: Project Description(use attachments if necessary): "`s `\ S i X ) 'S Tr4e! CtSS�� „ r lit\ Slt I�S Rhe I0 ?c �.� fl QloIMIV10Yh l oc-r.r2c( ail o 4Z 0 VJ v,, �- 6t-cc- �. Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: �a�kl„ j e�et IS °/� k X .�..�., t,L�to� 01�G/�11/tt!✓vi Area of wetlands on,lot:—)Z( square feet Percent coverage of lot: Closest distance between nearest existing structure and upland edge of wetlands: -J/A feet Closest distance between-nearest proposed structure and upland edge of wetlands: ^f//4 feet Does the project involve excavation or filling? No yes- If esIf yes,how much material will be excavated? per- cubic yards How much material will be filled? gae— cubic yards Depth of vi+hich material will be removed'or deposited: 11110"e- feet Proposed-slope throughout the area of operations:_4r114 Manner in which,material will be removed or deposited: 0114 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" .'4L4-- , 617.20 Appendix B Short Envirortmentat AssessMent Form Instructions for Completing Part 1-Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part-] 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 Spodsor,Information Name of Action or Project: r 1r�.yr +.. . �r Ge-t+`ti g'!1; 1�V if r s� C.-3_ S to-z,sx ' Project Location(describe,and attach a location map): Brief Description of Proposed Action: Jr lt/l?0 s td ✓tR t Name of Applicant or Sponsor: Telephone. 6116 S^ E-Mail: Address: City/PO: State: Zip Code: 1.Does the proposed adfion 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 inten"t of the proposed action and the environmental resources that [ F1 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: em 3.a.Total acreage of the site of the proposed action? _ /. acres b.Total acreage to be physically disturbed? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? /-ZtY_ acres 4. Check all land uses that occur on,adjoining and near the proposed action. E]Urban [-]Rural(non-agriculture) ❑Industrial E]Commercial oesidentiall(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page I of 4 tpC� 5. Is the proposed action, NO YES N/A a.A permitted use under the zoning regulations? ❑ b.Consistent with the adopted comprehensive plan? 6. is the proposed action consistent with the predominant character of the existing built or naturalNO YES landscape? ❑ pip 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: CJ ❑ 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'ofthe proposed action? {� ❑ LJ ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? P9 ❑ 9.Does the proposed action meet or exceed the state energyeode requirements? NO YES ! If the proposed action will exceed,requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing publiclprivate water supply? NO YES If No,describe method for providing potable water: { / ❑ 11.Will the proposed action connect-to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment: ❑ 12. a.Does the site contain a structure that is listed on either the State or National Register of Historic NO YES Places? 29 ❑ b.Is the proposed action Iocated'in an archeological sensitive area? 13.a.Does any portion of the site of the proposed action,dr 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? If.Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 14. Identify the typical habitat types"that occur on,or are likely to'be found on the project site.'Check all that apply: ❑Shoreline []Forest ❑Agricultural/grasslands ❑Early mid-successional ❑ Wetland (D 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? J ❑ 16.Is the project site located in the 100 year flood plain? NO YES TTTT 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? gJNO DYES {"I ❑ b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: �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: D 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: 0 ❑ 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? IfYes,describe: j F1 I AFFIRM TI4AT THE INFORMATION PROVIDED'ABOVE IS TRUE ANDACCURATE TO THE BEST_OF MY KNOWLEDGE Applicant/sponsorna • VSdt✓' r ""`r` Date: �-3 Signature Part 2-;Impact Assessment.`The Lead Agency is responsible for the,completion of Part 2. Answer all ofthe 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?" (Srew.-F) No,or Moderate small to large Impact Impact may may occur occur I. Will the proposed action create a material conflict with an adopted land use plan`or zoning regulations? El 2. Will the'proposed action'result in a change in the use or intensity of use of land? u__J 3. Will the proposed action impair the character or quality of the existing community? ❑ 4. Will the proposed action have an-impact on the environmental characteristics that caused the ❑ establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or ❑ ❑ affect-existing infrastructure for mass transit,biking or walkway? 6. Will the proposed action.cause an increase in the use of energy and it fails to incorporate ❑ reasonably available energy conservation or renewable eneM 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, EJ ❑ architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ a 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 problems? El El 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 Pan: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. MCheck 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 or 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 Appli/ "tion AFFIDAVIT Fi,%2"fT s %%ZQ3BEING 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. S'g at a of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF , 201 Public NOYARy PUBLIC-S ATE OIF NEW YORK NO. 01 CR6411895 QUALIFIED IN NASSAU COUNTY COMMISSION EXPIRES 12/07/26;, i APPLI CANUAGENUREPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town officers and employees.The puroose of this form is to provide inforination which can alert the town of possible confliotg df interest and allow it•to,take MLbhtever ao6on is necessary,4o avoid sdin YOUR NAME: (Last name,first name,qriddle 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 on from plat or official map Planning r r� Other eil,name the activity.)l-��vk�� �°-sN 4L Q 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 O _ If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of "S%3^vL- =�a-A Signator Print Name u>; •n/ M`►R- Form TS l 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- supporthig:facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shallnot 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#_ 100\ 10LJ� — G PROJECTNAME 9e�w.:�- �+r �•Pr•va�e, �r.,�� �� S�✓� The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,land transaction) ❑ (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval,license,certification: Nature and extent of action: Location of action: S� /V/+s.s ✓ f*)i R , 6ureO06 uC 'VY >! Site acreage: SS , 6 ?/ S�, ,�!. /. Z Y c�,•v� Present land use: a � Present zoning classification: . f 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: r � (a) Name of applicant: J✓S��^ �'r''� (b) Mailing address: 3 G C (c) Telephone number:Area Code( ) G` (O (d) Application number,if any: Will the action be directly undertaken,require funding,or approval by a state or federal agency? YesEl No J9 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. , 1 F]Yes No �(J 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 X 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 0 Yes ❑ No '12' 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 69Not 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 N�R,f_kpplicable % 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 Vg 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 0 No 0 Not Applicable PUBLIC COAST POLICIES Policy 9. Provide for public access to, and recreational use of, coastal waters, public lands, and public resources of the Town of Southold. See LWRP Section III--Policies; Pages 38 through 46 for evaluation criteria. Ye�] No KNot Applicable Attach additional sheets if necessary WORIUNNG COAST WLCIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section M.—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No 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 0 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 ❑ NoV9 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 Vy Not Applicable PREPARED BY f✓Sf^'0 TITLE AAe VC*-`'`, DATE 16 z l