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HomeMy WebLinkAboutTR-9936A Glenn Goldsmith, PresidentO``��F So�ryoTown Hall Annex A. Nicholas Krupski,Vice President h lO 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 �ycOUNTY,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE # 1853C Date: August 30, 2021 THIS CERTIFIES that the installation of a 4' high post and rail fence on beach in front of - -- ---- ---- ---------—------- ---- --- ----- ---- homedo------------------wn --- -- -------- -- --------- -- ----- - ------------- -- -- --------- -- - - -- --- to high tide line; At 3345 Cedar Lane, East Marion Suffolk County Tax Map #1000-37-7-10.2 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 13, 2021 pursuant to which Trustees Administrative Permit#9936A 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 a 4' high post and rail fence on beach in front of home down to high tide line. The certificate is issued to Vito Tanzi&Lena Triev-Tani owners of the aforesaid •o ty Authorized Signature Glenn Goldsmith,President SU!/jTown Hall Annex A. Nicholas Krupski,Vice President ,`OOl0 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III l Southold, New York 11971 Michael J. Domino G Q Telephone(631) 765-1892 Greg Williams �� a0 Fax(631) 765-6641 fUUNT`I,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD DATE OF INSPECTION: 8,3D INSPECTED BY: b� �r h. 275 Ch. 111 INSPECTION SCHEDULE Pre-construction, haybale-line/silt, boom/silt curtain 1St day of construction Y2 constructed Project complete, compliance inspection Liz t" 1r1*14e'P IAI 7/ ke ` 7 e dycr r`� a Lilt ly CERTIFICATE OF COMPLIANCE. Glenn Goldsmith,President �QF S Town Hall Annex 54375 Route 25 A. Nicholas Krupski,Vice President 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 ' COUNTY w� . 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 President 54375 Route 25 c P.O. Box 1179 John M. Bredemeyer III "p Southold,New York 11971 Michael J. Domino ` � Telephone(631) 765-1892 Greg Williams �'�� Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9936A Date of Receipt of Application: April 13, 2021 Applicant: Vito Tanzi & Lena Triev-Tanzi SCTM#: 1000-37-7-10.2 Project Location: 3345 Cedar Lane, East Marion Date of Resolution/Issuance: July 14, 2021 Date of Expiration: July 14, 2023 Reviewed by: John M. Bredemeyer, III, Trustee Project Description: Install a 4' high post and rail fence on beach in front of home down to high tide line. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows for the operations as indicated on the survey prepared by John C. Ehlers Land Surveyor, last dated July 1, 2021 and stamped approved on July 14, 2021. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a determination from any other agency. -6� 4-e" Glenn Goldsmith, President Board of Trustees SURVE**r OF LOTS 1(- 1 51 ,1 5 (2 90 4 F/O 155 MAP OF SECTION 2 1CARD INER5 BAY ESTATES ' SITUATE: EAST MARION iTOWN OF SOUTHOLD � SUFFOLK COUNTY, NY SURVEYED 10-11-2018, 11-05-2018 PROF. FENCES 07-01-2021 SUFFOLK COUNTY TAX # 1000 - 57 - 7 - 10.2 CERTHqHD TO: Vito TandoadWaY) L $93015 ima TAM—Tanzi. kasp- FirFirstAmc6m nde bmanm ChAaW "20 ilie -Plae Z 3 G1 0 0�. 0 qu -0, .0 jo -wo 111 !7j r + 011 c- C) 'Aa 0 e`4k & 5Z 0 4-- d q) W op Rr 4� 4k_ J 0, 'z, J'­A + jet Ivo tj) 0 Cil 0 7/ vo F Q J�. O APPROVED BY BOARD OF 1RUSTEES TOWN OF SOUTHOLDW-49 v DATE 9024 9 M Band al-r--fis NOTES: -LAnmutharizad alter r.dditlo, I od..r,.V.r. misp bearing m li d 1. MONUMENT FOUND 11 Viol.tion affection 72Q%w"b_1l,l ko oleate - guc:j. f4m Y.r St. ion Low 'Only copLae from the origin I "I:'r,.y k IS GATE 1,11 0121 1 1.,:o ovigin.1 of Lh:,,:� I"' 11 be on.ld.r.d to b.­I ld Ir. "pl-a" Tiortificetions Incicatod how,fon giLf,Lr., ELEVATIONS REFERENGE N6\vV'2cl FEMA PANEL NUMBER 36103CO177H44 6--a W.V� ,n,, n —11,1 J­­ I i :dj AREA 45,156 S.F. OF, 1.04 ACRES ...:On k_ LI.-are not to HC's _3 11"1 GRAPH I C, SGALE I = 40' JOHN C. EHLERS LAND SURVEYOR' 6 EAST MAIN STREET N.Y.S.UC.NO.5M RNERHEAD.N.Y.11901 631-369-8288 REF.Q1UnnVohn\DropboxN906WM8-1 84 updrx 10-201 8.pro Glenn Goldsm`'~^ president aS11FF0(�-c Town Hall Annex A. Nicholas-is `pski, Vice-President 54375 Route 25 John M. Bredemeyer, III y P.O. Box 1179 Michael J. Domino o Southold, NY 11971 Greg Williams y o! Telephone (631) 765-1892 Fax (631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: `TLP3 l -'3 v Completed in field by: Chris Mohr Landscaping on behalf of VITO TANZI & LENA TRIEV-TANZI requests an Administrative Permit to install a 4' high post and rail fence on beach in front of home down to hightide line. Located: 3345 Cedar Lane, East Marion. SCTM#: 1000-37-7-10.2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 XCh. 111 SEQRA Type: I 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: e`C)jL? ar : D'�1 J►s IrG`scil/ Gl�Gfh'l dk- S 1 /5�;4WI? �f Ad7r -'v P-4,/e I—C y I have read &acknowledged the foregoing Trustees comments: Agent/Owner: Present were: J. Bredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other .5M ! �i N r/Q�i7/ `S .4-e ola� gab PA4 J /W h Cot SY, �r GA (V SGaf �C gyp' '• /` " � dihy y�°�rv,{'%/h4 k� � 5�h 4v a G L e W)n — PLR*5 Iq R,5 IAI svb /)7 v/c- ,/"4 c-,/"4 1 c%w)n j Azw)d� 5URVEY -OF LOTS 151 , 155, MAP OF SECT! :2, 6, AR O- INERS BAY EwSTA7B5 SITUATE:pECE W � � t EA5TMARION TOMPF 5OUT14OLD APR 13 2021 �.� � - FOLK COUNTY, W Southold Town Board of Trustees SWT LK C"s TY TAX .1000 :10.2 s Tad F":Anvdm TW (asp i ale TIN ggr 3 t . g < 1 301 0 ' . �y a A: ?•� " I : J' ; r f3. { �. 0 Ot ` �"-' r5:, . {. r as; ` Z r t 4� } f' r r i Y j r' A Ikv ix A ` .�K{ �„ :• �. } ... A ;+�' �.'y,` CR "' �T'T .1baL+Y�i?�9'.' . ���'. Jf i�K'•';5:: .�i . },� {y `fir 3 -`�^'...... _. _ ¢ _, {T _ ;M 'pq pq,tOpp.w�r.. "�R� :P. �.F9: . �.Y�.� ATIK' r+ ! '4Q+A" +MWG +1A!PV ...r... ''7 Vie..,. §, S• ;,^.'9� } uR FEMA E ' UME 361 atFIF AReA 4=& OR 104 ACRS "UR 5CALE 0, 0� Joim ce SURVE 'r OF LOTS 1511156-160 4 P/O 155 MAP OF SECTION 2 CHAP?D I NER5 BAY ESTATES 5I TUATE a EA5T MARION � TOWN OF 5OUTNOLD 5UEEOLk COUNTY, NY SURVEYED 10-11-2018, 11-05-2015 PROP. FENGE5 0.7-01-2021 SUFFOLK GOUNTY TAX # 1000 - 57 - 7 - 10.2 CERTUM TO: Vito Tanzi „E gyp•roadway) FirkAmcdcanlWe oeCompany PlaCe, S93015450 ilw 35.P (aka Gedar Lane) k G O�N Qb 3� O ° g' 4 / �°� t�St0 �,o `fi ") / U) e�. js) d ° •3 ai C) c� x O s 4°� � ) ^�O u°Z- 0 O� OC O -W11/• a o°bt 45 � est�r J w ^� e 00 T i 0 _ N �i C' a dj 09� e .� 4ji ice i I! RL�1•QQ' � 1 JUL - 9 2021 Southold Town oar'of Trustee !�=',�°.Pj•-yam- �h�` NOTES: \ `Vnwthorized alteration or addition to a survey map boor tng v licanad land surveyor;"" r; a el!e e r iF �l ■ MONUMENT FOUND ; -'r y 1 ) violation of I'm ad 7209, ouo lvfalam 2, the n! 4� �',' No.Yerk SQ.Education L.., 'Only copies from the original of this aurvoy G GATE marked.tLh an ortg,nal of the lend aurveyor's T. �1 �'• �'i / etaap.d seal small he considered to ee valid true v _d•''-� copies` `certifications indicated hereon signifyy that tnfe 9Urvey.ae prepared In accordance.1th Ma as- \,)L"1(i. -+ feting Cade of Practice tar Lana Surveys adopted ELEVATIONS REFERENGE NG�/D'2a FEMA PANEL NUMBER 36103C0177H = _ _ _ = t'• trY the Na.Yo k State Avva[latlon oI leoelanol _ '/_ �i •��• Land Surveyor,. Said-It lflca tion.shall run only to the P.r..n for Mom the eurvey 1eprepared and on nue hdholt to the[Itla Cama any, 'avarnman- AREA = 45,156 S.F. OR 1.04 AGRE5 - tal agency and lending Institution Ifeted hereon, and to theslgnanaa pf Cha IendlnA ln.tltutlon. Corttflcv- [lens s.ere ot tronaferably to atltlltlonBl In.tltUt lone &RAPH I G SGALE I 11= 40' JOHN C. EHLERS LAND SURVEYOR 6 BAST MAIN STREET N.Y.S.LIC.NO.SM RIVERI[HADAY.11901 631-369-8US REF.C:1Usm\lobnU)MpboxWX9OMa-184 update 10-7018.pro �xacPe asa-r os�cm a►nm mx,m 06afb r, � s �Y 01A11 b�1,.� r P t f.' •r' A> P P %� P' A, f �' • � s . -12 F, ,'{ f Spi.p cord nt A F FF/ J L ��� _ ,,,, — -- ...� ---- �� _ -- wncE COUNTY OF SUFFOLK © x o. sovnxao sEcnoR NO G —�— a+l �,y -- Real Property Tax Service Agency v E " M as °• 037 N wr r a r rx�Nn.au __— --•-- a..u.--�-- yqP° P ss ,a xo top x,Nl PROPERTY MM OFFICE LOCATION: "c- MAILING ADDRESS: Town Hall AnnexP.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Southold, NY 11971Telephone: 631 765-1938 1J, 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 13, 2021 Re: Local Waterfront Coastal Consistency Review for VITO TANZI & LENA TRIEV-TANZI SCTM# 1000-37-7-10.2 Chris Mohr Landscaping on behalf of VITO TANZI & LENA TRIEV-TANZI requests an Administrative Permit to install a 4' high post and rail fence on beach in front of home down to hightide line. Located: 3345 Cedar Lane, East Marion. SCTM#: 1000-37-7-10.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is INCONSISTENT with the below LWRP Policy. Policy 9.3 Preserve the public interest in and use of lands and waters held in public trust by the state and the Town of Southold. Aerial photos (Figures 1 and 2) show the high tide wrack line landward of the property line and where fence is proposed in the west. Beach areas seaward of the high tide line are held in public trust. I� i�Ilr� r air l�rfV' N lyr 4 � 1 ii Ir i J( � rr i ✓1r�V �N J y X l ................................................ � Figure 1. Property Line and Apparent High Water Mark (2016). N 11 ane, L Owl uiin uro C� i '�„, + ;rg,res L fkRrrwmrau y7r^^wrIij;ai 3'u4,"B 4rum;rhui �r1 m r u 1 a I + �.0� I Vu°� IIIVNI a u i ullPuuiiiiui ����iillllllllllllllll � I II II, u r a If, / J ry � r ar;t'rU^tl�lo-r �, iljl I VJ fury%%iGi v " Figure 1. Property Line and Apparent High Water Mark (2010). Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Glenn Goldsmith,President � s _ ' s� Town Hall Annex �` A.Nicholas Kru 54375 Route 25 ski,Vice President °'`,*. " P `z P.O.Box 1179 John M.Bredemeyer III ` Southold,New York 11971 Ni Nf chael J Dominoi .a a.. 3 � � x„�� - Telephone(631) 765-1892 Fax(631) 765-6641 Greg Williams • BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only IL_ i 1 1' ` 1; Coastal Erosion Permit Application 1 APR 1 3 2021 Wetland Permit Application ,/ Administrative Permit — Amendment/Transfer/Extension Snuihold To,m PReceived Fee: $eceived Application: b � '�.21 Board ofiru;'res 160,,ompleted Application: Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Detennination Date: Coordination:(date sent): _ Z__LWRP Consistency Assessment Form Sent: CAC Referral Sent: _Date of Inspection: Receipt of CAC Report: Technical Review: _ Public Hearing Held: Resolution: Owner(s)Legal Naine of Property (as shown on Deed): V1-6 4- Lenz,-Tfl ev-- lCi-YLZ-I Mailing Address: �� MC4_50n_ l"1y e_ N Y 0030 Phone Number: Suffolk County Tax Map Number: 1000 - Property Location: I> 4ne__ �u S'�” �'►1�"10 r� /y �2�/ (If necessary,provide LII.CO Pole#, distance to cross streets, and location) Q 11 AG>✓NT(If applicable): .1r`�S ►1P' La rs L )w, Mailing Address: _ 40 �� l:J't�VIO Phone Number: - 1y3�'��0���/7 Email: Board of Trustees Application GENERAL DATA Land Area(in square feet): z Area Zoning: CS le SIC) Previous use of property: Intended use of property: 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? /No Yes If yes, provide explanation: Project Description(use attachments if necessary): Y) 3kgA � e� �,o �� ori 61s loe i n F� o �o�s� Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: 4p Kee- 4(e SS OxS&1 nnb o ✓) t S 4e— uS 1 14 r1a1 rte- A-p 40 w n r Qk n_- " wete-, WaA i M Jr-6 6,e� !!�� Area of wetlands on lot: 16-Wo square feet Percent coverage of lot: (�_O % Closest distance between nearest existing structure and upland edge of wetlands: 5 feet Closest distance between nearest proposed structure and upland edge of wetlands: ___7 6 feet Does the project involve excavation or filling? s No Yes IP yes, how much material will be excavated? /t/A cubic yards How much material will be filled? k✓)4- cubic yards Depth of which material will be removed or deposited: I(J 1� feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: /t/ 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): A.) /�" 61 Z20 Appendix B Short Environmental Assessment Form Instructions for Completin Part l -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: _ inn ee' Project Location(describe,and attach a location map): 33 Lls' C'ec)c,,r �c�sk pl a f- i 'A Y Brief Description of Proposed Action: Name of Applicant or Sponsor- Telephone: C r I �r )n5 E-Matto, r 5 Mdhr Gn4lo!� 9J4a.I AddO �S' _ as lss- ,L City/PO _ State: Zip Code: im _ V __._. . . t «3s_ 1 Does the propos�actiNonly 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 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: /�. S 3.a.Total acreage of the site of the proposed action? /00 acres b.Total acreage to be physically disturbed? , Q�Og acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? l#0 /u acres 4. Check all land uses that occur on,adjoining and near the proposed action. ❑Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial residential(suburban) ❑Forest ❑Agriculture ❑Aquatic ❑Other(specify): ❑Parkland Page X of 4 5. is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? S❑ b-Consistent with the adopted comprehensive plan? l❑J� L❑�1 6. is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? ❑ 12-1 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: J(� E]8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ®' ❑ 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO YES II'No,describe method for providing potable water: 2 ❑ 11.Will the proposed action connect to existing wastewater utilities? NO YES If No,describe method for providing wastewater treatment 4S cL _____ ❑ 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? rE5 El13,a.Does any portion of the site of the proposed action,or lands adjoining die proposed action,contain 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? 1:1If 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/grass(ands ❑Earlymid-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? 2— ❑ 16.Is the project site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or tion-point sources? NO YES If Yes, ❑ a.Will storm water discharges flow to adjacent properties? ❑NO YES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,brielly describe: E]NO AYES 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: 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: �-- 1 AFFIRM THAT THE INFORMA'T'ION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsor n e: _ rlpt 5 /4e JA---- __ Date:, 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 Inrge impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or Toning ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposed action impair the character or quality of the existing community? 4. Will the proposed action have an impact on the environmental characteristics that caused the El 1:1establishment of a Critical Environmental Area(CEA)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El 1:1affect existing infrastructure for mass transit,biking or walkway? F6. Will the proposed action cause an increase in the use of energy and it fails to incorporate El _ 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? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, ❑ waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or dt ainage F] ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? 1:1—Lo— Part 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, t�l that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. FJCheck 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 T 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 J Page 4 of 4 Board of Trustees Application AFFIDAVIT Vr o `- Lente-fne-v--fanzl BEING DULY SWORN DEPOSES AND AFFI_RMS 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 AGENTS) 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. I 7-> Signature of Prop Signature of Property- -Omfder SWORN TO BEFORE ME THIS DAY OF 1 (!IV , 20 WENE AIL SHELDON NO"Public,State of New York No.01SH6367330 Qualified In Suffolk County Com iWlon Expires 1111312021 Notary Public Board of Trustees Application AUTH[ORIZATION (Where the applicant is not the owner) 1/We, _ owners of the property identified as SCTM# 1000- 37 — 7—A962 in the town of &Z4 lyano A .New York,hereby authorizes to act as my agent and handle all necessary work involved with the application process for permit(s) from the Southold Town Board of Trustees for this property. Property Owner's Si Property Owner's Signature 67 I S� SWORN TO BEFORE ME THIS r DAY OF 20a) IRENE K S14ELDON Notary Public,State of New York No.01SHOUT330 Qualified in Suffolk County Notary Public Commission Expires 11/1312031 n } APPLICANUAGENT/REPRESENTATM TRANSACTIONAL DISCLOSURE FORM The Tonin of Sotnhold's Code of Ethics prohibits conlliLts of interest on the part of town officers and employees.The VuMose of chis form is to provide information which can alert the town ol'possihle conflicts of interest and allow it to take whatever actian is necessa[y to avoid same. � 11 YOUR NAME: z J e Ul (Last name,firstn'natne,middle initial,unless you are applying in tate 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 _V Y Mooring Exemption from plat or official snap Planning Other (If"Other",nattte the activity.)_ Do you personally(or through your company,spouse,sibling,parent,or child)have a relationship with any officer or employee of the Town of Southold? "Relationship"includes by blood,rttarriage,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 than5% f the shares. YES'- -- -- NO — Ifyou answered"YES–,complete the balance ofthis 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 applicandagenllrepresentative)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 applicgnt (when Ute applicant is a corporation); B)the legal orbeneFcial owner of any interest in a non-corporate entity(whorl the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Subtnittethi ay o98- 0`� Signature - S Print Name Form TS 1 r IRENE K SHELDON Notary Public,State of New York No.01SH6367330 Qualified in Suffolk County Cq n n"on Expittr s 1111312021 ' ' ' officersTRANSACTIONAL DISCLOSURE FORM The Town of Southold's Code of*Ethics prohibits conflicts orinterest on the part of town (Last name,first name,.ip iddle initial,unless you Ve appr�ng in the name of '*X someone else or other entity,such as a company.If so,indicate the other person's o,company's oomn.) NAME 0yAPPLICATION: (Check all that xpyly.) ` Tax grievance __---___-- Building Variance ______ Trustee Change ofZone __-___ Couotd8mdvn Approval vfplat -____ Mooring Exemption from plat oruK)nialmap Planning Other (If"OtheC'.name the acti"i\y.)_________ Doyou personally(or through your company,spouse,sibling, rchild)have urelationship with any*fOmxoremployee o[the Town ofSouthold? "Ku|mion^h/p'includes hyblood,muoiugv ocbusiness interest"Business ioter ,y'mouooahvuiuvx^. including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation inwhich thutown officer oremployee v*nomore than 5Y4ofthe shares. TLS NO I Fyouanswered"YE.S-,complete the balance orthis form and date and sign where indicated Name v{person employed bythe Town o[Snv'hdd________________-____-_ '[iUv"rposioonn[,butporsnn Describe the relationship between yourself(the vypUcoot/agenUrepmsenmdve)an(]the town officer orrmyloyo ,Either check the appropriate line A)through D}and/or describe iothe space provided. The town officer or employee or his or tier Spouse,sibling,paren�or child is(check all that apply): _____x)the ovnurof greater than 5%v[the shares of the corporate stock ofthe applicant (when the applicant i,uuv9wmhvo); B)the legal or beneficial owner of any interest in a naii-corporate entity(when the applicant ianot m:oq,unaivn); amofficer,director,partner,vremployee o[the applicant;or the actual applicant. DESCRIPTION 0PDECATl0v8BlP �_ --- ------- �~�~� hmhtedthi / Signaturt. 1--2w Print Na Form TS | IRENE K SNELDO0 NOWY Publit,State of Now York 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 ivithin 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 shatl 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# 3 7 - ? - /09 PROJECT NAME V 14—& tix nz 1 4- Le4ie-,— t're V —t&-, 1 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: y ' /eInce On n � ,µder-1� - s � - Location of action: 33 Rax-,0 rL rl)g3J Site acre igc:_ 1 6 Present land use: Sla Present zoning classification: RS�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 a plicant: Y4o !GLn? �,�.YLA.. II"I P_�7—�e�.✓1 Z i__-- (b) Mailing address: o�-� �A_5O✓l�r �i'I�j - s Iwo (c) Telephone number: Area Code (d) Application number,if any: A 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? 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,snakes 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 Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See I.WRP Section III—Policies Pages 3 through 6 for evaluation criteria U Iles ❑ No T1 Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes El No 2'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 1:1 Yes 1:1D No 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. ❑ ❑ ET f Yes No Not Applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LNMP 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 LVV" Section III—Policies; Pages 34 through 38 for evaluation criteria. L-1 Yes ❑ No I 2 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. ' 1:1Ye❑ (� No u Not Applicable Attach additional sheets if necessary - I WORKING OAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section IH­Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No E�'Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWIdP Section III—Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No 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 Z Not Applicable PREPARED BY TITLE �)i/ HATE 112LZ(