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TR-9965
Glenn Goldsmith, President O�*OF SO Town Town Hall Annex A. Nicholas Krupski,Vice President ,` 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III Southold,New York 11971 Michael J.Domino G • Telephone(631) 765-1892 Greg Williams 'Q Fax(631) 765-6641 �yComm,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD CERTIFICATE OF COMPLIANCE 18-51C Date: August 18, 2021 THIS CERTIFIES that the as-built reconstruction of existing previously permitted 180' long by 2%z' wide fixed catwalk-with 60 new posts; and as depicted on the project plan prepared by Annette Campbell, received on April 30, 2021, and stamped approved on August 18,2021; T At 1185 Fleetwood Road, Cutchogue Suffolk County Tax Map#1000-137-4-27 Conforms to the application for a Trustees Permit heretofore filed in this office Dated April 30, 2021 pursuant to which Trustees Wetland Permit#9965 Dated August 18, 2021 was issued and conforms to-all of the requirements and conditions of the applicable provisions of law. The project for which this certificate is being issued is for the as-built reconstruction of existing previously permitted 180' long by 2 %z' wide fixed catwalk with 60 new posts; and'as depicted on the project plan pirepared by Annette Campbell received on April 30,2021,and stamped approved on August 18,2021. The certificate is issued to Annette Campbell owner of the aforesaid property. ItIL -Authorized Signature R_ % BOARD OF SOUTHOLD TOWN TRUSTEES SOUTHOLD,NEW YORK PERMIT NO.9965 DATE: AUGUST 18,2021 t ISSUED TO: ANNETTE CAMPBELL PROPERTY ADDRESS: 1185 FLEETWOOD ROAD,CUTCHOGUE M SCTM#1000-137-4-27 AUTHORIZATION 14, Pursuant to the provisions of Chapter 275 of the Town Code of the Town of Southold and in t�l accordance with the Resolution of the Board of Trustees adopted at the meeting held on August 18, 2021, and in consideration of application fee in the sum of$250.00 paid by Annette Campbell and subject to the Terms and Conditions as stated in the Resolution, the Southold Town Board of Trustees authorizes and permits the following: 4 Wetland Permit for the as-built reconstruction of existing previously permitted 180' long by 2 V wide fixed catwalk with 60 new posts; and as depicted on the project plan prepared by .1m R Annette Campbell, received on April 30 2021 and stamped approved on August 18,2021. WITNESS WHEREOF,the said Board of Trustees hereby causes its Corporate Seal to be affixed, and these presents to be subscribed by a majority of the said Board as of the 18th day of August 2021. Ad V3F F TERMS AND CONDITIONS The Permittee Annette Campbell residing at 1185 Fleetwood Road, Cutcho,gue,New York as part of the consideration for the issuance of the Permit does understand and prescribe to the following: 1. That the said Board of Trustees and the Town of Southold are released from any and all damages, or claims for damages, of suits arising directly or indirectly as a result of any operation performed pursuant to this permit, and the said Permittee will, at his or her own expense, defend any and all such suits initiated.by third parties, and the said Permittee assumes full liability with respect thereto,to the complete exclusion of the Board of Trustees of the Town of Southold. 2. That this Permit is valid for a period of 24 months,which is considered to be the estimated time required to complete the work involved,but should circumstances warrant, request for an extension may be made to the Board at a later date. 3. That this Permit should be retained indefinitely, or as long as the said Permittee wishes to maintain the structure or project involved,to provide evidence to anyone concerned that authorization was originally obtained. 4. That the work involved will be subject to the inspection and approval of the Board or its agents, and non-compliance with the provisions of the originating application may be cause for revocation of this Permit by resolution of the said Board. 5. That there will be no unreasonable interference with navigation as a result of the work herein authorized. 6. That there shall be no interference with the right of the public to pass and repass along the beach between high and low water marks. 7. That if future operations of the Town of Southold require the removal and/or alterations in the location of the work herein authorized,or if, in the opinion of the Board of Trustees, the work shall cause unreasonable obstruction to free navigation,the said Permittee will be required, upon due notice,to remove or alter this work project herein stated without expenses to the Town of Southold. 8. That the said Board will be notified by the Permittee of the completion of the work authorized. 9. That the Permittee will obtain all other permits and consents that may be required supplemental to this permit, which may be subject to revoke upon failure to obtain same. 10. No right to trespass or interfere with riparian rights. This permit does not convey to the permittee any right to trespass upon the lands or interfere with the riparian rights of others in order to perform the permitted work nor does it authorize the impairment of any rights, title, or interest in real or personal property held or vested in a person not a party to the permit. --------- -- S_0__ - ------- --------------------------- -- - ------- Glenn Goldsmith,President F Town Hall Annex A.Nicholas Krupski,Vice President 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 couffm -- - - ------- - - -- -- ---- - --- BOARD-OF TOVVN-TRUSTEES - -- - - - TOWN OF SOUTHOLD August 23, 2021 Annette Campbell 153 Violet Avenue Cutchogue,"NY 11001 RE: 1185 FLEETWOOD ROAD, CUTCHOGUE SCTM# 1000-137-4-27 Dear Mrs. Campbell: The Board of Town Trustees took the following action during its regular meeting held on Wednesday, August 18, 2021 regarding the above matter: WHEREAS, ANNETTE CAMPBELL applied to the-Southold Town Trustees for a permit under the provisions of Chapter 275 of the Southold Town Code, the Wetland Ordinance of the Town of Southold, application dated April 30, 2021, and,- " - WHEREAS, said application was referred to the Southold Town Conservation Advisory'-Council and to the Local Waterfront Revitalization Program Coordinator for their findings and ------------recommendations,and; -- ------ -- — -- "WHEREAS, the LWRP Coordinator recommended that the proposed application be found Inconsistent with the LWRP, and, ` HE-R-E-ASi-the-Boar-d-ef-Trustees-has-fur-Cher-ed-polic-y-6.3-of-the-6ecal-Wateftnt-Revitaliz-ation Program to the greatest extent possible through the imposition of the following Best Management Practice requirements; increased board spacing to 1 '/" and the issuance of a permit; and WHEREAS, a Public Hearing was held by the Town Trustees with respect to said application on August 18, 2021, at which time all interested persons were given an opportunity to be heard, and, WHEREAS, the Board members have personally viewed and are familiar with the premises in question and the surrounding area, and, WHEREAS, the Board has considered all the testimony and documentation submitted concerning this application, and, WHEREAS, the structure complies with the standards set forth in Chapter 275 of the Southold Town Code, 2 WHEREAS, the Board has determined that the project as proposed will not affect the health, safety and general welfare of the people of the town, NOW THEREFORE BE IT, RESOLVED, that for the mitigating factors and based upon the Best Management Practice requirement imposed above, the Board of Trustees deems the action to be Consistent with the -----------------L--oval-Waterfront-Revitalization-P-rogram--pursuant to-Chapter--268-5-of-the-Southold_T-own_Code,_ and, RESOLVED, that the Board of Trustees APPROVE the application of ANNETTE CAMPBELL for the as-built reconstruction of existing previously permitted 180' long by 2 Y2' wide fixed catwalk with 60 new posts; and as depicted on the project plan prepared by Annette Campbell, received on April 30, 2021, and stamped approved on August 18, 2021. --�- ---- Permit-to construct-an-i-complete-projeot-wi[I-expire-two-years from-the--date-the-permit-is signed: --- Fees must be paid, if applicable, and permit issued within six months of the date of this notification. Inspections are required at a fee of$50.00 per inspection. (See attached schedule.) Fees: None Very truly yours, Glenn Go#smith President, Board of Trustees GG/dd C LAS 0 V E APA 3 0 2021 Buuthoicf Town Board pf Trustees �5(7 7 -9'2 74A a —/C-7 7 1/ b � . APPROV 'DY BOARD OF 1 RUSTEES -T(OMN`OF 'SOUTHOLD DATE., A- 7'!g� zoal g�FFO!j` � • Y Glenn Goldsm3 resident �Q Town Hall Annex A.Nicholas Krupski,-v ice President 54375 Route 25 John M. Bredemeyer III en �� P.O. Box 1179 Michael J. Domino Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: $JIB/Z� Completed in field by: ANNETTE CAMPBELL requests a Wetland Permit for the as-built reconstruction of existing previously permitted 180' long by 2 Y2' wide fixed catwalk with 60 new posts. Located: 1185 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-27 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 N/ 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: j�c��- d�gl� �pc��,� �e��,e,, � � i�� � �p a�c�fw�✓J�-- � —�O QAJu_C-. W614 N"J40 &ep AA I 3/Z3 Z 1 Pf, )e,� P1445 I have read & acknowledged the foregoing Trustees comments: 44A��Ati_c Agent/Owner: / Present were: Bredemeyer ✓ M. Domino /G. Goldsmith N. Krupski YG. Williams Other Glenn Goldsmith,President ( so(jT, Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 "P P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 Michael J.Domino to Telephone(631) 765-1892 Greg Williams ':R� � -Q Fax(631) 765-6641 BOARD OF TOWN TRUSTEES s TOWN OF SOUTHOLD July 23, 2021 Annette Campbell 153 Violet Avenue Floral Park, NY 11001 RE: Wetland Permit Application for a Dock 1185-Fleetwood Road, Cutchogue SCTM# 1000-137-4-27 Dear Ms. Campbell, Regarding your current Wetland Permit application for the reconstructed dock at the above referenced property, as discussed with you during your public hearing meeting that was held on July 14, 2021 the Board of Trustees will meet you at your property on Tuesday, August 10, 2021 to further discuss the existing dock in person with you. P The public hearing for your dock application will be re-opened and,possibly discussed further on August 18, 2021. It is recommended you either attend this meeting in person or via the Zoom based webinar if possible, unless otherwise advised by the Board of Trustees. Enclosed for your reference is the Public Notice of Hearing form that shows the new Zoom Meeting ID and Password numbers you will need in order, to log onto the August 18, 2021 public hearings. You do not have to do any more paperwork at this time, this form is simply for your reference in order to log into this August 18, 2021 Zoom meeting. If you have any question regarding your coming site inspection meeting, or the public hearing meeting, please do not hesitate to contact the Trustees office and ask to speak with either Trustee Nick Krupski or Trustee Glenn Goldsmith. Sincerely, '15� . Glenn Goldsmith, President Board of Trustees l i Glenn Goldsm (resident �Q$UFFOj - Town Hall Annex A Nicholas KrupsKI; v Ice President 54375 Route 25 John M. Bredemeyer III C P.O.Box 1179 coo Michael J. Domino Southold,NY 11971 Greg Williams � ph� { Telephone(631)765-1892 Fax(631),765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: shoA i Completed in field by: I� Ate, ANNETTE CAMPBELL requests a Wetland Permit for the as-built reconstruction of existing previously permitted 180' long by 2 '/' wide fixed catwalk with 60 new posts. Located: 1185 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-27 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 5 years: Y/N. Wetland Line by: C.E.H.A. Line Additional information/suggested modifications/conditions/need for outside review/cbhsultant/application completeness/comments/standards: ,pia- klf Ocie 6e4wew 6c,,tk ot.) 4 IN 4, w6w� ,,411 �tp AA I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: Bredemeyer G. Goldsmith ski Z G. Williams Other Glenn Goldsmith,President Qf So�ly Town Hall Annex A.Nicholas Krupski,Vice President p 54375 Route 25 i". � P.O.Box 1179 John M.Bredemeyer III Southold,New York 11971 Michael J.Domino cr+ Telephone(631) 765-1892 Greg Williams Fax Fax(631) 765-6641 COMM BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD July 23, 2021 Annette Campbell 153.Violet Avenue Floral Park, NY 11001 RE: Wetland Permit Application for a Dock 1185 Fleetwood Road, Cutchogue SCTM# 1000-137-4-27 Dear Ms. Campbell, n Regarding your current Wetland Permit application for the reconstructed dock at the above referenced property, as discussed with you during your public hearing meeting that was held on July 14, 2021 the Board of Trustees will meet you at your property on Tuesday, August 10, 2021 to further discuss the existing dock in person with you. The public hearing for your dock application will be re-opened and possibly discussed further on August 18, 2021. It is recommended you either attend this meeting in person or via the Zoom based webinar if possible, unless otherwise advised by the Board of Trustees. Enclosed for your reference is the Public Notice of Hearing form that shows the new Zoom Meeting ID and Password numbers you will need in order to log onto the August 18, 2021 public hearings. You do not have to do any more paperwork at this time, this form is simply for your reference in order to log into this August 18, 2021 Zoom meeting. If you have any question regarding your coming site inspection meeting, or the public hearing meeting, please do not hesitate to contact the Trustees office and ask to speak with either Trustee Nick Krupski or Trustee Glenn Goldsmith. Sincerely, ��44a 4, Glenn Goldsmith, President Board of Trustees Glenn Goldsmi,' resident ��,`S11FFOj,�' u Town Hall Annex A.Nicholas Krupski,-vice President O er III y'"c 54375 Route 25 John M. Bredeme Y P.O. Box 1179 Michael J. Domino Southold,NY 11971 Greg Williams � � Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD / Date/Time: 6�8"/�) 3,6o Completed in field by: ANNETTE CAMPBELL requests a Wetland Permit for the as-built reconstruction of existing previously permitted 180' long by 2 '/2' wide fixed catwalk with 60 new posts. Located: 1185 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-27 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=q 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 J Ch. 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: As 6, 4 4 ? V)as Ae-N-e a ?sP_v�o05 COAWA � I o,� 01 mina_ I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J/J. Bredemeyer I/M. Domino ✓ G. Goldsmith N. Krupski I/G. 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Main Rd. &Youngs Ave.) Southold, NY 11971 ® Telephone: 631765-1938 COUa 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 11, 2021 Re: Local Waterfront Coastal Consistency Review for ANNETTE CAMPBELL SCTM# 1000-137-4-27 ANNETTE CAMPBELL requests a Wetland Permit for the as-built reconstruction of existing previously permitted 180' long by 2 '/z' wide fixed catwalk with 60 new posts. Located: 1185 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-27 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 recommended as INCONSISTENT with the LWRP policies. 6.3 Protect and restore tidal and freshwater wetlands. A. Comply with statutory and regulatory requirements of the Southold Town Board of Trustees laws and regulations for all Andros Patent and other lands under their jurisdiction. 1. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions. The catwalk was replaced without a Wetlands Permit. Note that a permit was issued for the catwalk in 1991 (3961). 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 �0%%)FFOt,re d� Peter Young,Chairmany Town Hall,53095 Main Rd. Lauren Standish,Secretary 5 P.O.Box 1179 -*A ?'E" Southold,NY 11971 Telephone(631)765-1889 Fax(631)765-1823 Conservation Advisory Council Town of Southold At the meeting of the Southold Town Conservation Advisory Council held June 9, 2021 the following recommendation was made: Moved by John Chandler, seconded by Carol Brown, it was RESOVLED to SUPPORT the application of ANNETTE CAMPBELL to replace deteriorating and dangerous catwalk to same specifications as existing. Located: 1185 Fleetwood Rd., Cutchogue. SCTM#137-4-27 Inspected by: Carol Brown, John Chandler The CAC Supports the application, however, there was concern with the height and should be verified to the high tide. Vote of Council: Ayes: All Motion Carried Glenn Goldsmith,President 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD nV E C Only This Section For Office Use 0 '1y Coastal Erosion Permit Application APR 3 0 2021 v Wetland Permit Application- Administrative Permit 'Amendment/Transfer/Extension - ' Received Application:, 'Received Fee: $ Completed Application: 2-1 Incomplete: 'ssihca n: Type I Type Classification: 11 Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: __/_'oordination:(date sent): LWRP Consistency Assessment Fo Sent: r 1a) Receipt of CAC Report:, Technical Review:, Public Hearing Held: ., - :_ �- /ylol� Resolution: nJ 0h-f co t�Plde Owner(s)Legal Name of Property (as shown on Deed): /t✓t_ C MailingAddress: Phone Number: e, 15-1/0 z Suffolk County Tax Map Number: 1000 - zs- Property Location: . (If necessary,provide LILCO Pole 4, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: f 0, 711c 1d4 6 1 - -1 L r Board of Trustees Application GENERAL DATA Land Area(in square feet): Area Zoning: zm Previous use of property: Intended use of property: zC_ _ 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 V 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.? b Yes No y 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): /� /��� t� /�/(�/� 7 22 Fid f ,5 T�CQ -= Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: g/ w , . t Area of wetlands on lot: square feet Percent coverage,of lot: % Closest distance between nearest existing structure and upland edge of wetlands. feet r ; Closest distance between nearest proposed structure and upland edge of wetlands: feet Does the project involve excavation or filling? V No- Yes If yes,how much-material will be excavated? cubic yards How much material will be,filled? ___Subic yards s Depth of which material will be removed or deposited:; feet Proposed slope throughout the area of operations': _ 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): 617.20 Appendix B Short Environmental Assessment Form 'triistrn'etions for Qom»letin�, 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 l based on information currently available. If additional research or investigation would be needed to fully i 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,l-Project and Sponsor Information Name of Action or Project: Project Location(describe,and attach a location map): Brief Description of Proposed Action. Name of Applicant or Sponsor: Telephone: .�/U��� C��� � ��✓G E-Mail: Address: City/PO: State Zip Code: 1.Does the`propdsed 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 ❑ 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? acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? 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 t of 4 5. is the proposed action, NO VES 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 natural NO YES landscape? M 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: ❑ 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO ��YES L_1 b.Are public transportation service(s)available at or near the site of the proposed action? c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? ❑ 9.Does the proposed action meet or exceed the state energy code requirements? ,NO YES If the proposed action will exceed requirements,describe design features and technologies: ❑ 10. Will the proposed action connect to an existing public/private water supply? NO' YES, If No,describe method for providing potable water: EJ 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' ❑ 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? ',E b.Would the proposed action physically-alter,or encroach into,any existing wetland or waterbody? El ❑ If Yes,identify the wetC nd or waterbody and extent of alterations. s are 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, ❑S reline El Forest ❑Agri cultural/grasslands 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? F91 E 16.Is the project'site located in the 100 year flood plain? NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, a.Will storm water discharges flow to adjacent properties? - NO DYES D b.Will storm water discharges be directed to established conveyance systems(eNflf(o and storm drains)? If Yes,briefly describe: DYES Page 2 of 4 . J 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: '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: 20.Has the site of the proposed action or an adjoining property been the subject of remediation(ongoing or -NO YES completed)'for hazardous waste? if Yes,describe: I AFFIRM THAT THE INFORMATION.PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY' r KNOWLEDGE, Applicant/spon for 'ame; /,�� Date: t 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 I 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 I, Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? E 2. Will the proposed action result in a change in the use or intensity of use of landsEj 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 energy opportunities? 1:1 7. Will the proposed action impact existing: O a.public/private water supplies? b.public/private wastewater treatment utilities? a 8. Will the proposed action impair the character or quality of important historic,archaeological, Ef 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)? LJ 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 Pa rt 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. 3. z z i t 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 NameofLead Agency Date President ---- Print o T peNan of esponsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT page 4 of 4 Board of Trustees Application 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 VIE 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 PRESENTATIVES,INCLUDING THE' CONSERVATION ADVISORY COUNCIL,TO-ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES"IN CONJUNCTION WITH THIS APPLICATION, INCLUllING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDIT ON OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. ignature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS c DAY OF Jt'r tkL, , 20 CAROL R HARBAJAN NOTARY PUBLIC-STATE OF NEW YORK No 01 HA6281716 Notary kbliC Qualified in Queens County My Commission Expires 06-13-202 APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM ' The To ofSouthold'sCotl •affi#h." .` - i •tscanfiic afintere t=ont`e 'oto of#"cers-andeni lo`ees,The` u -sea , this-form" rm rovi a iriforinat'o w iclr can a the town of o 'b c confli c,r infe d` ow into'i whatever-a i6n is necessarp'ta a'vo}d'saine. YOUR NAME: � (Last name,frst name,qiiddle initial,unless you are applying in the-name of someone else or other entity,such as a company.If so,indicate the other person's or company's name.) _ } NAME OF APPLICATION: (Check all that apply.) Tax grievance Building Variance Trustee , Change of Zone Coastal Erosion ' Approval of plat Mooring Exemption from plat or official map, Planning Other } (If"Other,name the activity.) Do you personally,(6rthroughy""—, mpany;spat;sibling,pafent;%orcFtilc�)haafe,alelatio�nshi0,.w1lh: ohicir ?r,e'mployee u of the Town.otSbi bald? "Re(adotiship"includgs,by„bloody axriage,,ar`busine s:infer sf:`$usinvss i ter�itieans a bu§in ss, including a partnership,,in which the'tpwn,of Peror''e"itipiloye, hzW vewa,partiol'bi3tiiership df(or;emplgyment b}%),a corlmration in which the town oftrcer ar,employe0=owtis,,mj, re thzaa° J�of t ares. ' s YES NO 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 t Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check ; the appropriate line A)through D)_andlor describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,o'r child,is(check all that apply): W),the'oWfieriofgreater4han;56/ofthe"SharesofWccorpoiple,stockdf lie,ipp�glic�r►t- -•„(iarhenChe.appticant;isa;ctr��+tfori};; _ _ - B)=the lcgiil�r'beneticiaf'oAvnei'of any Interestin anon-corporate eptity'(w*j�ilte H applicant.is not.a Orpoodion), O)an officer,director;partner,oremployee oflh&zpplicdht,Oe D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted ; �da of �11/17�" 20,14 Signature Print Name A! Pri Form TS 1 Glenn Goldsmith,President O�OSCO Town Hall Annex A.Nicholas Krupski,Vice President ,may` G�� 54375 Route 25 John M.Bredemeyer III o P.O.Box 1179 Michael J.Domino 6 Southold,NY 11971 Greg Williams Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD June 18, 2021 Annette Campbell 153 Violet Avenue Floral Park, NY 11001 Re: Board of Trustees Application of Annette Campbell 1185 Fleetwood Road, Cutchogue SCTM# 1000-137-4-27 To Whom It May Concern: You are receiving this letter as notice that, in accordance with the Governor's Executive Orders, this application is now scheduled to be heard by the Southold Town Board of-Trustees via a combination of an in-person meeting and videoconferencing on Wednesday, July 14, 2021 beginning at 5:30 P.M. Please continue to check the Town's website as the meeting date approaches for the latest meeting agenda and videoconferencing information. Enclosed is an informational notice regarding the videoconferencing meeting and how to access the online meeting. Please mail a copy of the informational notice along with all other required paperwork to each of the adjacent property owners. Please keep a copy of said informational notice for your records so that you can access the meeting in order to have a conversation with the Board during your application review. ry Truly Yo rs, , 44-h,� Glenn Goldsmith, President Board of Trustees vt S11FF0(-k��'. Glenn Goldsmith, President r �Q COTown Hall Annex A.Nicholas Krupski,Vice President � Gym 4 54375 Route 25 r John M. Bredemeyer II] u y P.O. Box 1179 Michael J.Domino O Southold,NY 11971 Greg Williams Telephone(631) 765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BE ADVISED — AS PER CHAPTER 55 NOTICE OF PUBLIC HEARINGS Failure to submit the following originals to this office by or no later than 12:OOPM the day prior to the scheduled Public Hearing for your application will result in a postponement of said application. This office WILL NOT contact you to request said information: • All original white & green certified return receipt mail receipts stamped by U.S.P.S. • Completed original Proof of Mailing Form Failure to submit the following originals to this office by or no later than 12:OOPM the day of the scheduled Public Hearing for your application will result in a postponement of said application.- • Original Affidavit of Posting form — DO NOT COMPLETE SAID FORM UNTIL THE GREEN SIGN HAS BEEN IN PLACE ON THE PROPERTY FOR AT LEAST SEVEN (7) FULL DAYS. Sign the form on the eighth day that the green notice of hearing sign has been up on said premises: All green signature cards related to said application that were returned to your office should be either dropped off in our "Trustee drop box" or mailed into odr office whenever they ,are received. These cards are not required prior to the Public Hearing, unless specifically requested for by this office. This specific requirement is subject to change. Board of Trustees Apply ;ion PROOF PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME & SCTM#: NAME: ADDRESS: 137-- y -a� L/_ STATE OF NEW YORK --- - - - COUTNY OF SUFFOLK residing at being duly sworn; deposes and says that on the day of ,20__, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that-the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office located at 1_that_said-Natices.were mailed-lo each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Signature Sworn to before me this Day of , 20� Notary Public Glenn Goldsmith, President � FF0(`1-e Town Hall Annex A.Nicholas Krupski,Vice President b1@0 Gy � 54375 Route 25 John M. Bredemeyer III ro P.O.Box 1179 Michael J. Domino Southold,NY 11971 Greg Williams 4,, ® ap! r Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ANNETTE CAMPBELL COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING DO NOT COMPLETE THIS FORM UNTIL AFTER POSTING REMAINS INPLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, eA1W;Z? e!:M ,t'�Usiding at/dba 77040AI /P�• L' y o z being duly sworn, depose and say: That on the Of 7day of `f''VAle , 20 I personally posted the property known as 1 `G'F�FTl ou-o by placing the Board of Trustees official noticing poster where it can easily be een from the street, and that I have checked to be sure the noticing poster has remained in place for a full seven days immediately preceding the date of the public hearing. Date of hearing noted thereon to be held Wednesday, July 14, 2021. Dated: 0-::(—I C) C�p� signature) Sworn to before me this day of3QLLj 20G ( CAROL R HARBAJAN NOTARY PUBLIC-STATE OF NEW YORK No.01 HA6281716 Qualified in Queens County Notary Public My Commission Expires 05-13-202(a Board of Trustees Application PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME& SCTXV'#� rO�7 ' �'" ? T NAME:_- M �', _ -ADDRESS: STATE OF NEW YORK COUTNY OF SUFFOLK residing at Uf_ A/q a!%Js� , being duly sworn, deposes and says that on the _day of ,77/Nf, ,20�, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office located at f' IC 114,,5C � - toC4e 4 oe.4 L 1-* 1,-that_said Notices_were mailed to each of said persons by CERTIFIED MAIL/RE RECEIPT. Signature Sworn to before me this Day of920 CAROL R HARBAJAN NOTARY PUBLIC-STATE OF NEW YORK (',12, No.01HA6281716 Qualified in Queens County Notary Public W Commission Expires 05-13.202 / - • o 1a cV RECEIPT ca c0E3.11.15,10MI111I ca Certified Mad Fee e/ $eted l .bU 3. 0 JrI � T,, �a 0(3 ^Jy Extra Services&Fees(checkbaK add fee r�espprewfli +, Extra Services&Fees(checkddiNpOXAM .� ❑ Return Receipt(hardcopy) $ 1.•t� �t���U! \�\ �3, I ❑Retum Recelp�t�,([(ajl p $ C—\; •°� pO Q Return Receipt(electronic) - $ -u i' `POstnl (K) I O Q Return Receipt(e(8�o(� o) $ - --r JUp� �tOStmar .� 4 ❑Certified Mail Restricted Delivery $ aj Her ❑Certified Mall Restricted Delivery S 0 E]Adult Signature Required - $--- VD� O ' p ❑Adult Signature Required $ Q Adult Signature Restricted Delivery$ � (" I ❑Adult Signature Restricted Delivery$ - ~ �� p Postage 0.S5 ,}�C`J p Postage -. c A / 1 ft 1 Total Postage and F _ Total Postage and Fees cO Sent To CO Sent T a Lila/ �'G �' a- __ ,/ �1� �' -= ----------- --------------- -----------------------------=-------------- ------------- ---- C3 Str�an Age:No or PO Boz IV: p Street end,pt No. � o: _ L `~ r.• g - -----=---------- i Crty State,21P+4® // Cr Stat r+d / r T :11 1 11 111 - :11 1 1.1 TM v AIL �^ 1 O REECE m s. e p :Dome40ic Wil • nlY 43, CO !�- J] pp „!] � �• ! ��• "• E� i � CUtf 1��{ IVI (p�g��, , Certified Mall 1 )3188 ; _Bi= r i ` Certified Mail Fee "'" - 7 e> 3 $3.67119,,_t*Re�rn es,&Fe sllc box,add fee a�pppp e - $ '` hO GL 77 aroma $ IJ'L ; it Extra ServlCes&Fees(check box,aria tee a I I i t te� i E 1. ( nil i ❑Return Receipt(hardcopy) $ I' C3 ❑ ceipta nlc) $ (-. hptrit ❑Certified Mall Restricted Delivery $ t7� Here ❑Return Receipt(electronic) $ v ! Po'�ar1p� ❑Atlult Signature Required $ 4' ? O ❑Certified Mall Restricted Delivery $ _ H re ❑Adult Signature Restricted Delivery$ - I C Adult Signature Required $--- + <� Q lit Q Adult Signature Restricted Delivery$ 9 b pC!' Postage $0.5c `mo 5 r i p Postage �� O Total Postage and F e� ?C121 $ $i, tl� ?/fly fYl g 1 a[!!1 m Total Postage and Fees 2�rbA _�f $ - $7.00 Sent co $ ept Tv °` - G'C/G '-------------------------------------- a //U�/=�-�GL aIle— D St et an P012-21--_PN_o.i -;� --o p trees antlE3pt.No or PO City State,ZIP+4® (7 61'er / :10 1 11 111•1 :11 1 Ir•1 NOTICE OF HEARING NOTICE IS HEREBY GIVEN that a Public Hearing concerning this property will be held by the Southold Town Board of Trustees both in-person and via the online Zoom platform. OWNER(S) OF RECORD: ANNETTE CAMPBELL SUBJECT OF PUBLIC HEARING: For a Wetland Permit for the as-built reconstruction of existing previously permitted 180' long by 2 %' wide fixed catwalk with 60 new posts. Located: 1185 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-27 TIME & DATE OF PUBLIC HEARING: t Wednesday, July 14, 2021 — at or about 5:30P.M. — To access the Zoom meeting please see the meeting agenda located in the Trustees section of the Town website. If you have an interest in this project, you are invited to view the Town file(s) through the Southold Town website. To view the application-files please visit: https://www.southoldtownny.gov At the bottom of the picture on the main screen click on the second button from the right "Town Records, Weblink/Laserfiche"; go to bottom of page and click on "pg. 2"; click on "Trustees" folder; click on "Applications"; click on "Pending"; all files are listed by name in alphabetical order. Click on the name of the application to view the file. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 �Zzz, Glenn Goldsmith,President \OSUfFO(/�-COG Town Hall Annex A.Nicholas Krupski,Vice President �� y,,, 54375 Route 25 John M.Bredemeyer IIIA P.O.Box 1179 Michael J.Domino Southold,NY 11971 Greg Williams 'I, dap! Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD May 28, 2021 Annette Campbell 153 Violet Avenue Floral Park, NY 11001 Re: , Board of Trustees Application of Annette Campbell 1185 Fleetwood Road, Cutchogue SCTM# 1000-137-4-27 To Whom It May Concern: You are receiving this letter as notice that, in accordance with the Governor's Executive Order 202.1, this application is now scheduled to be heard by the Southold Town Board of Trustees, via videoconferencing on Wednesday, June 16, 2021 beginning at 5:30 P.M. Please continue to check the Town's website as the meeting date approaches for the latest meeting agenda and videoconferencing information. Also enclosed is an informational notice regarding the videoconferencing meeting and how to access the online meeting. Please mail a copy of the informational notice along with all other required paperwork to each of the adjacent property owners. Please keep a copy of said informational notice for your records so that you can access the meeting in order to have a conversation with the Board during your application review. _ Very Truly Yours, 4&_�4y Glenn Goldsmith, President Board of Trustees /y 1 Glenn Goldsmith,President ,y00 ff0(k Town Hall Annex A.Nicholas Krupski,Vice Presidentra� y� 54375 Route 25 John M.Bredemeyer III ti ? P.O.Box 1179 Michael J. Domino �y 0�� 1 Southold,NY 11971 Greg Williams 'h0/ �`���r Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD WORK SESSION & PUBLIC HEARINGS WEDNESDAY, JUNE 16, 2021 5:OOPM & 5:30PM A Regular Work Session and Public Board Hearings of the SOU_T_H_OLD TOWN BOARD OF TRUSTEES will be held on Wednesday,-June 16, 2.021 with the Work Session beginning at 5:OOPM and Public Hearings beginning at 5:30PM. Pursuant to Executive Order 202.1 of New York Governor Andrew Cuomo in-person access by the public will not be permitted. Town residents are invited to attend the public meetings virtually via the Zoom online platform. Written comments may also be submitted via email to the Trustees Clerks at elizabethc@southoldtownny.gov and diane.disalvo@town.southold.ny.us. Said comments will be considered at the public hearing provided that they are submitted no later than-12:00 P.M. (Prevailing Time) on the day of the public hearing. The public will have access to view and listen to the meeting as it is happening via Zoom. If you do not have access to a computer or smartphone, there is an option to listen in via telephone. Further details about how to tune in to the meeting are on the Town's website at https://www.southoldtownnV.gov/calendar or call the Board of Trustees office at (631) 765-1892 Monday through Friday between the hours of 8:OOAM—4:OOPM. Options for public attendance: • Online at the website zoom.us, click on "join a meeting" and enter the information below. Zoom Meeting ID: 957 4891 8038 Password: 845569 • Telephone: Call 1(646) 558-8656 Enter Meeting ID and Password when prompted (same as above). In order to "request to speak" when the application you are interested in has begun, please press *9 on your phone and wait for someone to acknowledge your request. When prompted to unmute your phone press *6. To view the application files please visit: https://www.southoldtownny.gov At the bottom of the picture on the main screen click on the second button from the right "Town Records, Weblink/Laserfiche"; go to bottom of page and click on "pg. 2"; click on "Trustees" folder; click on "Applications"; click on "Pending"- all files are listed by name in alphabetical order. Click on the name of the application to view the file. Glenn Goldsmith, President Oo�FF� Town Hall Annex A.Nicholas Krupski,Vice President 54375 Route 25 John M. Bredemeyer III CD z P.O. Box 1 179 Michael J. Domino �r Southold,NY 11971 Greg Williams 'y� �p�'V ' Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BE ADVISED — AS PER CHAPTER 55 NOTICE OF PUBLIC HEARINGS Failure to submit the following originals to this office by or no later than 12.00PM the day prior to the scheduled Public Hearing for your application will result in a postponement of said application. This office WILL NOT contact you to request said information: • All original white & green certified return receipt mail receipts stamped by U.S.P.S. • Completed original Proof of Mailing Form Failure to submit the following originals to this office by or no later than 12:OOPM the day of the scheduled Public Hearing for your application will result in a postponement of said application: • Original Affidavit of Posting form — DO NOT COMPLETE SAID FORM UNTIL THE GREEN SIGN HAS BEEN IN PLACE ON THE PROPERTY FOR AT LEAST SEVEN (7) FULL DAYS. Sign the form on the eighth day that the green notice of hearing sign has been up on said premises. All green signature cards related to said application that were returned to your office should be either dropped off in our "Trustee drop box" or mailed into our office whenever they are received. These cards are not required prior to the Public Hearing, unless specifically requested for by this office. This specific requirement is subject to change. Dard of Trustees Applicat_� i PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME: Q __(FIs� e., �-�, ( 6�'- 4-at- - w STATE OF'M c� .ccs 77)r- /Q COUTNY OF . ._ _ ses and says that on the --=��°' 1� Ma��n 3 ed a true copy of the Notice set forte :F 4_ the above named persons at the: .. - - esses set opposite the names of said , :gent assessment roll of the Town of S___ _ Post Office located at that-said-Notices were mailed to each of said persons by CERTIFIED MAIL/RETURN RECEIPT. Signature Sworn to before me this Day of 120 Notary Public arr Glenn Goldsmith,President �l'O�S oto' � Town Hall Annex A.Nicholas Krupski,Vice President !tA. 54375 Route 25 John M.Bredemeyer III y P.O.Box 1179 Michael J.Domino � � Southold,NY 11971 Greg Williams ,��1 �ap0 Telephone(631)765-1892 Fax(631)765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD BOARD OF TRUSTEES: TOWN OF SOUTHOLD --------------------------------------------------------------- In the Matter of the Application of ANNETTE CAMPBELL f COUNTY OF SUFFOLK STATE OF NEW YORK AFFIDAVIT OF POSTING DO NOT COMPLETE THIS FORM UNTIL AFTER POSTING REMAINS IN PLACE FOR AT LEAST SEVEN DAYS PRIOR TO THE PUBLIC HEARING DATE I, Al"/ L/ I Usiding at/dbaT/�G ���jW)eOA /P�• being duly sworn, depose and say: That on the 4 7day of YUAlf- , 20 I personally posted the property known as by placing the Board of Trustees official noticing poster where it can easily be een from the street, and that I have checked to be sure the noticing poster has remained in place for a full seven days immediately preceding the date of the public hearing. Date of hearing noted thereon to be held Wednesday, July 14, 2021. Dated: o �� signature) Sworn to before me this (p day of)%3U.I 20GI CAROL R HARBAJAN NOTARY PUBLIC-STATE OF NEW YORK No 01HA6281716 Qualified in Queens County Notary Public My Commission Expires 05-13-2020 Board of Trustees Application PROOF OF MAILING OF NOTICE ATTACH CERTIFIED MAIL RECEIPTS APPLICATION NAME & S. TM# NAME ADDRESS: _ _ -• STATE OF NEW YORK COUTNY OF SUFFOLK / residing at being duly sworn, deposes and says that on the _day of `7- /AV,F, ,20�, deponent mailed a true copy of the Notice set forth in the Board of Trustees Application, directed to each of the above named persons at the addresses set opposite their respective names; that the addresses set opposite the names of said persons are the address of said persons as shown on the current assessment roll of the Town of Southold; that said Notices were mailed at the United States Post Office located at /' �'//� �� • /- O eX L Z-*..e 1,that said_Notices were mailed to each of said persons by CERTIFIED MAIL/RE RECEIPT. Signature Sworn to before me this Day of 520 CAROL R HARBAJAN NOTARY PUBLIC-STATE OF NEW YORK No.01HA6281716 Qualified in Queens County Notary Public My Commission Expires 05-13.2026 i R © ■ ■ I ,..nom'-- mmrlqw� C13 co .� Cu /` Wi ° Certified y.60 �OIL` p Certified Mad Fee 13.60 e7 C` 6� /t $ $ Extra SeNI es&Fees(checkbox{ad 7 at ' to G ❑RetumRecei�t PYl $ _( t/r Rosimar Extra Services&Fees(check box ed$d fee r (�C I p ❑R�urn Receipi`�afWah ) t/UN ❑Retum Receipt(hardcaPY) �1•�\` jZ�• ' Retum Receipt(electronic) $ 1 i,u '� U't'aStm (Kl p ❑Certified Mall Restricted Delivery $ ` C3 ❑ m,t rnl i, � Herm E=l $, `� Qo ❑Certified Mall ResWcted Delivery $— 'r"'T""— ❑Adult Signature Required Cr-33 ❑Adult Signature Required - $ � I []Adult Signature Restricted Delivery$ a, •J,1„ ❑Adult Signature Restricted Delivery$ �'n p Postage 1 - 71.75 C3 Postage' $0.�.t s 1_ ! 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Located: 1185 Fleetwood Road, Cutchogue. SCTM# 1000-137-4-27 TIME & DATE OF PUBLIC HEARING: Wednesday, June 16, 2021 — at or about 5:30P.M. — To access the Zoom meeting please see the meeting agenda located in the Trustees section of the Town website. If you have an interest in this project, you are invited to view the Town file(s) through the Southold Town website. To view the application files please visit: https://www.southoldtownny.gov At the bottom of the picture on the main screen click on the second button from the right "Town Records, Weblink/Laserfiche"; go to bottom of page and click on "pg. 2"; click on "Trustees" folder; click on "Applications"; click on "Pending"; all files are listed by name in alphabetical order. Click on the name of the application to view the file. BOARD OF TRUSTEES * TOWN OF SOUTHOLD * (631) 765-1892 Town of Southold LW-RP iCONSISTIMC`Y ASSESSMENT FORM A. INSTRUCTIONS L 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�'Iiroposed "action ,Al, be evaluated,:as to ,its; scant �; beneficial ancl.aclyerse effects-utao'n.thect�as#'alp�rea-,i�rhichtincludos atlQ£S��itholdTouvii3. 3t 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. Xhit& each ain wer,imust:be c�iinl iateili in,Aefail, li i ]bo#h-s�[tal oking and non- ;suijtDorti,nli:f:3cis. If an action cannot be certified as consistent with the LWRP policy standards and ` conditions,if shall not be undertaken. 3 , S 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 i PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board ElBuilding 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: C ' Location of action: /���� lT�/ /� �- Site acreage: -14 U S.-14 Present land use: Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant: (b) Mailing address: /�',3 ��d G 15- r (c) Telephone number:Area Code4w'.�"6L9'7—el lD 4!j24 4 (d) Application number,if any: -w Will the action be dir ly undertaken,require funding,or approval by a state or federal agency? F Yes ❑ No If yes,which state or federal agency.? x 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 LWR.P Section III-Policies; Page 2 for evaluation criteria. ❑Yes ❑ No D 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-Poli ' s Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section HI Pages 6 through 7 for evaluation criteria Yes ❑ No Not Applicable } Attach additional sheets if necessary' NATURAL COAST POLICIES Policy 4. Minimize loss of ' e, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pa s 8 through 16 for evaluation criteria Yes' .- No Not Applicable 3, Y 4 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 I for evaluation criteria ; ❑ YesEl 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 iteria. ❑ ❑ Yes NoI'Ot 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 thro 4 for ev luation criteria. i - F Yes o Not Applicable k Attach additional sheets if necessary Policy 8. Min' 'e envir nmental degradation in Town of Southold from solid waste ,and hazardous substance astes. ee LWRP Section III--Policies; Pages 314 through 38 for evaluation criteria. Q ta 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. ❑ YeD No MNot Applicable Attach additional sheets if necessary s f WORKING COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations;Not, e WRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ,Q Yes n Nopplicable 3 Attach additional sheets if necessary Policy 11. Prom5' Nfot stainable use of living marine resources in Dong Island Sound, the Peconic Estuary and'Tows. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. Yes No Applicable Attach additional sheets if necessary Policy 12. Protect agric ltural.lands in the Town of Southold. See LWRP Section III --Policies; Pages 62 through 65 for eval tion criteria. Yes No Not Applicable S Attach additional sheets'if necessary Policy 13. Promote ap ropriate use and development of energy and mineral resources. See.LWRP Section III---Policies; ges 65 through 68 for evaluation criteria. ❑ Yes ❑ No Not Applicable PREPARED BY � DATE