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HomeMy WebLinkAboutTR-9959A Glenn Goldsmith, President �0 sovp'- Town Hall Annex A. Nicholas Krupski,Vice President ,`O ��� 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 �0 �� Fax(631) 765-6641 UNT`1,� 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-donstrudtion',"hay bale lino/silt boom/siltcurtain X 1 St L'lll`T A16- "q5P&-T '/2 constructed i When,project complete, call for compliance inspection; Glenn Goldsmith,President O��QF SoU�yOI 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 �0 �� Fax(631) 765-6641 COUNTI,� BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9959A Date of Receipt of Application: July 20, 2021 Applicant: Steven Israel & Cara Longworth SCTM#: 1000-70-10-60 Project Location: 1100 Beachwood Lane, Southold Date of Resolution/Issuance: August 18, 2021 Date of Expiration: August 18, 2023 Reviewed by: John M. Bredemeyer, Trustee Project Description: Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis)to not less than 12" in height by hand, as needed (6,120sq.ft.+/-). 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 or!the site plan prepared by Michael A. Kimack, received on'July-20', 2021, and stamped approved on-August 1.8, 2021. § 275-5 Permit procedures. (i) Cutting of common reed (Phragmites australis) to within 12 inches of the soil surface landward of the wetland boundary. This does not include mowing to ground level. Special Conditions: Do not disturb native vegetation during the hand cutting of Common Reed (Phragmites australis), including but not limited to; Eastern Red Cedar (Juniperus virginiana), Northern Bayberry (Myrica pensylvanica), Marsh Elder (Iva frutescens), and Groundsel Bush (Baccharis halimfolia). The approved operations must be commenced within two (2) years from the date of the resolution. The permittee is required to provide the Trustees with before and after photos of the area within this time period before any further maintenance is conducted. 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. b�`� Glenn Goldsmith, President Board of Trustees ECEDME BEACHWO OD ROAD Amoca .� N\_0_1 JUL ® 202 2• � EDGE OF PAVEMENT �outhotct Town Board of,TruSteeS. UTILITY v \\ PHRAGMITE CUTTING AND POLE `�l� MAINTENANCE AREA: 6,120 SF+I- R-196 -00 1__19600 � 'o0,4 LA A \ , o; LOT , cP � ISRAELI LONGWORTH PROPERTY 1100 Beachwood Road, Southold, N.Y. S, XSc'� PHRAGMITES OSI syr •� �O � PROPOSED PHRAGMITE �,o�pp �o lc� lo, 'p� CUTTING & MAINTENANCE AREA ' Represented by Michael A. Kimack o �\ O 9 \ Date: July 17,2021 0j CERTIFICATION I hereby certify that this is a Template of the Existing Site Plan By Ralph Heil,Licensed Surveyor dated 3/3/2021 with an overlay O �OOQS I �W of the Proposed Phragmite Cutting Area 5(� No details or features which could bear upon this O G°,�\,�S JQI 470 ^ application have been omitted /&C O _ Michael A. Kimack,_Agent, July 17,2021 SURVEY OF cF IS GMITES LOT 53 �, o M P OF �o �G< �� ®� � pp ytc` SOUTHWOOD , LOT NOS �° 1 - 53 , INCLUSIVE °� o FILED ON NOVEMBER 24, 1953 O,°1 ' 253, AS MAP No. 2141 �-r , SI TUA TE TOWN OF SOUTH OLD G SUFFOLK COUNTY, NEW YORK �� TAX No. 1000-07000-1000-060000 o SCALE 1"=20' C/ MARCH 3, 2021 /�� Cl) AREA = 13,779.49 sq. ft. 0.316 ac. / / r AERIAL LAND SURVEYING, D.P.C. NOTE: LOCATIONS AND EXISTENCE OF ANY 53 PROBST DRIVE SUBSURFACE UTILITIES AND/OR STRUCTURES NOT READILY VISIBLE, ARE NOT CERTIFIED. THE SHIRLEY, NY 11967 CERTIFICATIONS HEREON ARE NOT TRANSFERABLE. PHONE: 833-787-8393 E—MAIL: SURVEYSOAERIALLANDSURVEYING.COM WEBSITE: WWW.AERIALLANDSURVEYING.COM THIS SURVEY IS SUBJECT TO ANY EASEMENT OF RECORD AND ANY OTHER PERTINENT FACTS WHICH A TITLE SEARCH MIGHT DISCLOSE 11 DISTRI T:1000 LOT:O60.000 BLOCK:10.00 SECTION:070.00 =UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A r �m•;;P 'OV� LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF ARTICLE 134, MAP/F LE NO.: 2141 SECTION 7209. SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAPP r' '`BOAR OF I TRUSTEE 'Copies from the original of thin survey map not marked with an original of the land ourveyor'a Inked seal or his embossed coal chall not be T�\pJ ,y ��r�14UT�J® n conoidered'a valid true copy.* 'Certification indicated hereon mignify that 'J1/ �J f 1 �iAP 0 °'MAP OF SOUTHWOOD, LOT NOS 1-53, INCLUSIVE" la gid'"�i�porln York State a o�Patanco with the io�of Practice Profoalonal Land Surveyors. Sold certifications shall run only to the ®ATE parson for whom the survey la pre aced, and an his behalf to the title 202 TITLE 0.: SP45164—S �� tg, company,governmental agency and lending Institution. Certifications are LED DATE: NOVEMBER 24, 1953 not transferable to addltlonai institutions or O us+, EW COUNT TAX MAP ID: 1000-07000-1000-060000 �Q' SLP H hF� 0p CO SITUATIfD AT: TOWN OF SOUTHOLD SUBDIVISION MAP LOT#'S: 53 c> ® SPANO ABSTRACT SERVICE CORP. - Lai FIRST AMERICAN TITLE INSURANCE COMPANY U_ COPYRIGHT 2021 RALPH NEIL, 5 U Z O 5 J O AERIAL LAND SURVEYING, D.P.C. S STEVE ISRAEL �c �Q- W CARA LO GWORTH JOB No.: 21-651 LAND 5 U DATE: MARCH 3, 2021 — suFFs Glenn Go With, President �0 ;p Town Hall Annex A. Nidfbias Krupski, Vice-President' ,��� Gti 54375 Route 25 John M. Bredemeyer, III o 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 Michael A. Kimack on behalf of STEVEN ISRAEL & CARA LONGWORTH requests a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, as needed. (6,120sq.ft.+/-) Located: 1100 Beachwood Lane, Southold. SCTM#: 1000-70- 10-60 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_kl 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: '/.;-e A� -hy — 1 k� V J� I have read & acknowledged the foregoing Trustees comments: Agent/Owner: Present were: ZjBredemeyer M. Domino G. Goldsmith N. Krupski G. Williams Other BEACHWOOD ROADAga \ D *0, 0 �0 v P��, JUL 2 ® 2021 o� ,��•0 PGS � �� EDGE OF PAVEMENT eQutho-Id T( vans OJCj • �\ `Q���fl SOHrCl �a of Trustee \G� _ UTILITY PHRAGMITE CUTTING AND POLE �� �� �� MAINTENANCE AREA: 6,120 SF+I- R==196 -00 /_ _ R= O196 • wkp . 0.rla p� P.O.B. �o Cf,- 0 �AppO GJ OQF�FL A ' \ c�y� PG�i s� o; LOT ISRAELI LONGWORTH PROPERTY 1100 Beachwood Road, Southold, N.Y. C')5� p �� \ PHRAGMITES O�I 7%, PROPOSED PHRAGMITE ��o � C.\O0 qaF�' CUTTING & MAINTENANCE AREA Represented by Michael A. Kimack 9 \ Date: July 17, 2021 @P 8 6 ' CERTIFICATION y� Dy 40151 I hereby certify that this is a Template of the Existing Site Plan �0 OO 6 J' I By Ralph Heil,Licensed Surveyor dated 3/3/2021 with an overlay yaO�QS 1 of the Proposed Phragmite Cutting Area �yG Rl No details or features which could bear upon this O V C? application have been omitted. N \RF' �ft O N rQo)- Q�%t,�j -T (3 )C� C) 10 Alk: N Michael A. Kimack,-Agent, July 17, 2021 _ + SURVEYOF � PRRAGMITES � Ay � LOT 53 MAP OF SOUTHWOOD LOT NOS 1 - 53 , INCLUSIVE ��•o / FILED ON NOVEMBER 24 1953 01 01 AS MAP No. 2141 r SI TUA TE TOWN OF SOUTH OLD SUFFOLK COUNTY, NEW YORK �� TAX No. 1000-07000-1000-060000 SCALE 1"=20' , -(NV MARCH 3, 2021 AREA = 13,779.49 sq. ft. ; 0.316 ac. AERIAL LAND SURVEYING, D.P.C. NOTE: LOCATIONS AND EXISTENCE OF ANY 53 PROBST DRIVE SUBSURFACE UTILITIES AND/OR STRUCTURES NOT READILY VISIBLE, ARE NOT CERTIFIED. THE SHIRLEY, NY 11967 CERTIFICATIONS HEREON ARE NOT TRANSFERABLE. PHONE: 833-787-8393 E—MAIL: SURVEYSOAERIALLANDSURVEYING.COM WEBSITE: WWW.AERIALLANDSURVEYING.COM THIS SURVEY IS SUBJECT TO ANY EASEMENT OF RECORD AND ANY OTHER PERTINENT FACTS WHICH A TITLE SEARCH MIGHT DISCLOSE DISTRICT:1000 LOT:060.000 BLOCK:10.00 SECTION:070.00 'UNAUTHORIZED ALTERATION OR ADDITION TO A SURVEY MAP BEARING A LICENSED LAND SURVEYOR'S SEAL IS A VIOLATION OF ARTICLE 134, MAPFILE NO.: 2141 SECTION 7209, SUBDIVISION 2, OF THE NEW YORK STATE EDUCATION LAW 'Caples from the original of this survey map not morkod with an original of the land ourvayara Inked coal or his embossed coal shall not be considered a valid true copy." 'Certification indicated hereon signify that c, „ this auresy was Prepared In accordance with the exicting Code of Practice MAP OF: MAP OF SOUTHWOOD, LOT NOS 1-53, INCLUSIVE for Land Surveys adopted by the New York State Aeaoclation of Profoalonal Land Surveyors. Sold cartiflcations shall run only to tho person for whom the survey Is prepared, and on his behalf to tho title TITLE NO.: SP45184—S company, governmental agency and lending Institution. Cortigcationa aro MAP FILED DATE: NOVEMBER 24, 1953 not transferable to additional Institutions or a Oaen E�y COUNTY TAX MAP ID: 1000-07000-1000-060000 ��' p�-QF� Nf� 0 Co SITUATED AT: TOWN OF SOUTHOLD SUBDIVISION MAP LOT S: 53 y P o SPANO ABSTRACT SERVICE CORP. - O FIRST AMERICAN TITLE INSURANCE COMPANYCOPYRIGHT 2021 RALPH HEIL. �s OSTEVE ISRAEL AERIAL LAND SURVEYING,0. C. lS'� 020 CARA LO GWORTH Joe NO.: 21_651 1 LANID S U DATE: MARCH 3, 2021 BEACHWOOD ROAD EDGE OF PAVEMENT \G�Pe�Gt� - �� \�` 4-9� UnLITY:*;� `r POLE R_196.00 — — — P. B. -7, rn s s � � 00 so 0�r LOT N�g 53 `� •°O,I LOT < y�� , �c ¢8 6' DO ��$ ti NOOSE 4+ C, 0 SURVEY OF / v LOT 53 �c o MAP OF - SOUTHWOOD, LOT NOS �� °°o�1��'° ; 1 -53, INCLUSIVE FILED ON NOVEMBER 24, 1953 3• AS MAP ,No. 2141 �o SI TUA TEOO'pOOG* TOWN OF, SOUTHOLD �G J X .0 �ooa A SUFFOLK COUNTY, NEW YORK y roti ^� TAX No. 1000-07000-1000-060000 o� SCALE 1"=20' �v MARCH 3, 2021 AREA = 13,779.49 sq. ft. / 0.316 ac. AERIAL LAND SURVEYING, D.P.C. NOTE LOCATIONS AND EbSTENCE OF ANY 53 PROBST DRIVE SUBSURFACE UTILITIES AND/OR STRUCTURES NOT VISIBLE1 SHIRLEY. 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'w 0 I . w ' " _ " AVE I+'+I w a 53 w 11a em � "• �,n S -0 e,rBaEE BE0.G NI2o 0 �J r B w sBB,NBIn�� rawN a a m- zr m.x ma m.] m?m1 may? 2, w _._�� souTHan D 9 5. g ukmH �e N 5w r L "w'"' "` `" "" — —' -- --"-- NOTICE onU COUNTY OF SUFFOLK © N n souTHOfp SECTION NO c —�— w r21t ??�Real Property Tax Service Agency v m Nww..w _ __ .� cwml c.nN RNwHw.e.N Y„N, ow B e 070 A D..0w �), w.. �)ly.. ,— —_— --•-- 0r.w--r-- rzw rmc)x0 rr Yom" P ere Ns 1800 P0.0PERTV MAP OFFICE LOCATION: � ' ��� MAILING ADDRESS: Town Hall Annex w P.O.Box 1179 54375 State Route 25 Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) Telephone: 631 765-1938 Southold, NY 11971 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, AICP LWRP Coordinator Date: August 9, 2021 Re: LWRP Coastal Consistency Review for STEVEN ISRAEL & CARA LONGWORTH SCTM# 1000-70-10-60 Michael A. Kimack on behalf of STEVEN ISRAEL & CARA LONGWORTH requests a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to not less than 12" in height by hand, as needed. (6,120sq.ft.+/-) Located: 1100 Beachwood Lane, Southold. SCTM#: 1000- 70-10-60 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP policies and therefore CONSISTENT with the LWRP provided: 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 ;mow Glenn Goldsmith, President. {%`? Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President , P.O.Box 1179 «,,,,�,qqdi �'t John M.Bredemeyer III Southold,New York 11971 Michael J.Domino r ` 'ry '' e : � Telephone(631) 765-1892 Greg Williams ' {}` Fax(631) 765-6641 NTi BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application2 0 2021 Wetland Permit Application �—Administrative Permit Amendment/Transfer/Exten40 ` � Southold Town Received Application: Boar f Trustee _Received Fee: _Completed Application: 1sZm.zL Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: Coordination:(date sent): �_LWRP Consistency Assessment Form Sent: CAC Referral Sent: _Date of Inspection: Receipt of CAC Report: Technical Review: Public Hearing Held: Resolution: Owner(s)Legal Name of Property(as shown on Deed): � ��,/� !S'1�i4E4CAR—A., LDi(//(>aZOl Mailing Address: 8D /Y6YWCVY2 CIP&.41i O Yom/? Aly C OV.C, V-Y. -7-7 , Phone Number: �,— «� Suffolk County Tax Map Number: 1000 - Property 000 -Property Location: ZIQ__0 _,,._� C/ 101/0 5-V V7'c-YCVGAQ MX &97/ (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): &IGYWZL A Mailing Address: ? 0 ROX 1047 Soy O_e0- N—Y !11'7.1 Phone Number: X16 452?- 64 D7 Einai1:14 A<"/Y Cle9 V—Y�Q/Z2A ZVe Board of Trustees Application GENERAL DATA Land Area(in square feet): 7 7 4 Area Zoning: Previous use of property: jFAMD,&V rlN L ®4,�Z jCA l/Gy ZVI &ARW Intended use of property: &LVArM; A1- 44#11--Y &V &A 44 6 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 X 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 .X 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?_ aC Yes No Prior permits/approvals for site improvements: Agency Date ;2XUD E-' A10 �✓ f 7�!' /0�26 /fid,0.9O No prior permits/approvals for site improvements. Has any pennit/approval ever been revoked or suspended by a governmental agency?_ ;�C No Yes If yes,provide explanation: Project Description (use attachments if necessary): 7D C'(J ➢'" � z1 �g�l/?�S �o A AW&1,-7- of 4l°�,f��X= !?''4�0� &lF �6,/2- Board of Trustees Application WETLAND/TRUSTEE LANDS APPLICATI®N DATA Purpose of the proposed operations: TO tm G17"-°, /M P'Z-AOV,,t�'- ll�l V4,571 V� � _e_6�-J/Z�V�� 7� Q2 16V A NR COAy tZAZQf- CUA"/&6 H14//y/J'4"ZV C5 r-d C A ZF-,& 66) X&AR ete—RM PES Area of wetlands on lot: 15/20 square feet �A Percent coverage of lot: ®.: ) % Closest distance between nearest existing structure and upland edge of wetlands: 14 feet Closest distance between nearest proposed structure and upland edge of wetlands: / feet Does the project involve excavation or filling? _No Yes If yes, how much material will be excavated?_��cubic yards How much material will be filled? cubic yards Depth of which material will be removed or deposited:�M feet Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: &AA4V CUZV& eea o wi C , pls�dL ,�K 11v 7-DIZII1/ 4 AIA061G 4 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): NO AQ'EE CY' dN rZA41- V A ZT ER E 61Z20 Appendix B Short Environmental Assessment Form hstructions For ConiAletin Part 1 -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part 1 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 1-Project and Sponsor Information Name of Action or Project: Project Location(descri e,and attach a location map): � 00 �` � a av QST N. . 11971 Brief Description of Proposed Action: /2 "��o� dr�r�.4 eQ USS" �or� Plld 2A&/-117.-s AR,4,4 Name of Applicant or Sponsor: �Tei lephone - ( 14 C'C Ma /N, C�' Address: r ..mj6 City/P0: State: Zip Code: =2 11971 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YES administrative rule,or regulation? If Yes,attach a narrative description of the intent of the proposed action and the environmental resources that 1PU 'Ri 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 dor>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 F-1 Aquatic ❑Other(specify): ❑Parkland Page 1 of 4 5. Is the proposed action, R NO YES N/A a. A permitted use under the zoning regulations? Q - b.Consistent with the adopted comprehensive plan? Q Q 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? Q 7. Is the site of tate proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: — __u 9 ❑ S. 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? Q c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? Q 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: �/� ❑ 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? Q b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? Q If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: 0r kLeAala.'' c. eke 'Pry 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: Shoreline ❑Forest ❑Agricultural/grasslands El Early mid-successional Wetland ❑Urban Dri 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? M ❑ 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, gi Q a.Will storm water discharges flow to adjacent properties? VNO QYES b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe. � l� ,w•w •___ QNO []YES• Y 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: e _________ '�� .__ � ❑ 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: 1 AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE BEST OF MY KNOWLEDGE Applicant/sponsorname: 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 lit rge impact impact may may _ occur occur I. Will the proposed action create a material conflict with an adopted land use plan or zoning ❑ ❑ regulations? 2. Will the proposed action result in a change in the use or intensity of use of land? ❑ 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)? F-1 El 5. Will the proposed action result in an adverse change in the existing level of traffic or 1:1affect existing infrastructure for mass transit,biking or walkway? El 6. Will the proposed action cause an increase in the use of energy and it fails to incorporate F]reasonably available energy conservation or renewable energy opportunities 7. Will the proposed action impact existing: Y __ Ela.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, ❑ a waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate small to large impact impact may may occur occur 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage ❑ problems? 11. Will the proposed action create a hazard to environmental resources or human health? Part 3-Determination of significance. The Lead Agency is responsible for the completion of Part 3. For every question in Part 2 that was answered"moderate to large impact may occur",or if there is a need to explain why a particular element of the proposed action may or will not result in a significant adverse environmental impact,please complete Part 3. Part 3 should,in sufficient detail,identify the impact,including any measures or design elements that have been included by the project sponsor to avoid or reduce impacts. Part 3 should also explain how the lead agency determined that the impact may or will not be significant.Each potential impact should be assessed considering its setting,probability of occurring, duration,irreversibility,geographic scope and magnitude. Also consider the potential for short-term,long-term and cumulative impacts. Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. EICheck this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Fuge 4 of 4 Board of Trustees Applii� .'ion AFFIDAVIT 0'4LD,trs,( az rh� BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SIIE 1S THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) ANI) THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER K TJOWLEDGE AND BELIEF, AND THAI' ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVE D BY THE SIJUTIIOLD TOWN BOARD OF TRUSTEES. THE APPLICANT A.GR.EES TO HOLD THE TOWN OF SOUTHOLD AND THF, 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 APPILICATION, I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO) MY PROPERTY TO INSPECT THE PRE 115ES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROP)?11I1TI AND AS REQUIRED TO INSURE CO'VIPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERM IT. Sign, Mr, 'Property Owner Si nal o' rope Owner T SIA,ORN TO BEFORE MI_: TI41S ,___�y otary Pub is JAN10E E. LONGWORTH � Notary Public, State of New York Registration#01 L04802255 Qualified In Nassau County aod� Commission Expires September 30,2B+fl _ Board of Trustees Appli om,.�-,=,ion AUTHORIZATION (Where the applicant is not the owner) owners of the property identified as SCTlt4# 1000- ZQ fin- in the town of New York, hereby authorizes -- _1�2LL4, �A.�•���,gG __.___ _ to act as my agent and handle all necessary work involved with the application process for permit(s)from the Southold Town Hoard of Trustees for this property. P y Owner's Signature. Prop rty wner's Signature - - --- 5'T,FV0 /Z244L 4/CA WORT / SWORN TO BEFORE ME THIS f �% DAY OF 20g - - Notary Public JANICF-,"E. LONGWORTH Notary Public, State of New York Registration#01 L04802255 Qualified In Nassau County Commission Expires September 3Q,241-&: oZ 6 l A I'PI,I CAIII'I YAGIP,N'I'/fi rPRI!,SLd:NTATIVE TRANSACTIONAL DISCLOSURE FORM 7_hc`ft���n StrUtll�ls� t'ntle cif f lfticJlphihits�c�ntlictti nt:intett:t on the ;art of town oiTicors id rm 10 ccsr.The 1)irputiu rl this form r tg_�1rUYldejnii�unat,,n%Lich can alert e lolvn gi f�oSsit'le uont]ic�ts ol_interest nail Lou it to take .vhalever rcti��r.-is necessa to avoidsaniq, YOUR NAME: - i Last narnc, first name,piddle initial, unlc;ss yuu are applying in 1 the name of someone else or other entity,such Its it company. If so, indicate the otter •;erson's of company's narne.) NAME OF APPLICATION: (Check:dl that apply.) Tax enevance Building ).Tice -- - Trustee - X -- Change ot'7one - Coastal Erosion -- Approval of plat _ — - -_ ;Flooring Exemption from plat or official map - P Flailing — — Othcr —- -- (If"Ufher", mune the activi(V.) [)o you faersona;ly cur thrnng11 your eumpanv>bpouse,sibling,praent,or child)have at relationship with any offi,xr or employee- of diel own of Southol(l? '`ReIaG.)nship''irwluc:es by blood,mall Cage,or business interest "1:3usincss interest"means a busines•., including a partnerah p, in which the(L)wn officer,)r employee h.s even a partial ownership of(or employment by)a curporrtio;. in ,Nhic'h the town()flrc•e r or cmpl tyre awns more than 'i io of:ire shirrs. VIIS NO it L tic,nlm� of ed-Y ii 1;1',cnrnpiete the•balance of tlws Corm and vitae arnt sign where indicated Nance of person eiripluyed by Ile'I own of southula Title or pQSitlon of thi,t f�cisot, - -"- -' —• Dc.-ihe the relalwreship betw=1 ,ourself(the appiIcantin genVrepresenliltive),and the town oflic.er or employee hither chert, th(•appropriate line A),It rough D) ind/or descril>,y.n the space pn:videt'. 1 fie t„Lvri oflic:ei or enrplo�ee ur hi;or hrr spouse, ;ihhnparent or ef,dd is(check all that apply) -A)the c)v rref 0°L;(l'atef than 5%of the shan's o!'tt,e Lor.,oj rte st••ck of the applicant (%tiller the applicant is a .orporation); ii)the legal or brnelicial owner of any rrt0.t:st in rr nun ,:oit)orate entity lwhd n the applicant i.)nor it corporation), an offtcei,dire.:tor,partner,or employee of the applic,euu;or the actual applicant. DESCRIPTION OF RFLATIONSI"IIP Submitted this- �y — �l 20, Signaturc, Print Name Form TSI - ' -- .'�'E --- ------- -- APPIJCA,NT'/AG]C;]W'1'/IZEPRIIrSENTATIVE TRANSACTIONAL DISCLOSURE FORM I hg_(g��rLot bio (li•�Ic('s{c tl�c f f l it �luhits ct�ntli:[ti c;f Intcrc;t.qrr tfic h;,rt of town oflicen and e i la 'ft c nu otic of Ihis form is tg�roviLc iitfutn)_)�i�n�alitcft_g<m illerLlh towtt sit-n 1"i-1 u,n11i as 1'Interesl and allow it to lake whatev�cu Is neees>ttry to avoid samk- 4�Si- YOUR NAME: (Last name;,tir3t name,,)liddle L'iltial, L nlrss you are applying in the name of someone(:Ise or other entity,such its it campany.If so, indicate the other person's or company's names) NAME OF APPLICA'I ION- (Check all that apply•) 1'u grievance "•suilding _ V tit iance --- 1 ru>tee ---# Change of Zone (oast a Approval of plat ---- Mooring l>rosion g ----`— Excmption from plat or o111citd n.11) - Planning -- -' Other �-�- (lf"Other",name the ac(ivity ) f)u ,'uu lx:rsontdly(ur rnongh y,,;r co:npan},,spuusc,srblin);,parc;nt,ur child)have a relattunshtp with any officer or en;llitycc• ofthe 1'own of'Southold? "Pe latronship' includes by blood. ill aniage,or business intclCA"Business interest"ineait v busier,., including a partnership, in which the town ulficer or employee has cvt n a partial ownership of(or cnlpioyment by)a ctnporitioti in%4hrrh the town uflic•t•r or rmployce mvns enure.than 5°.0 of titu spar,%s Esti NO -- It'-cu amwered•YC'i",c,nn?Icte the balance C,Cthis fol n' 1110 date till r•,ign where indreiad Marne of person ernplay:d by the '-own of Southold --— —--- — tile or position of th,r(pctson Describe the rela(iouship bej%veen tourself(the appheant�agent rt:prescntauve)unci the town officer or employee. l,'itltcr rherk tl.c appropriate line A)through C))and/or describe it,the space provide'. Che town otllcet or enip oyec kir his at her spouw,;iblirig, patent or cluld is(check all that apply): A)(hc u,�ner t,f'L;ret.tcr than 5`X ufthe Aon:;of du,c•ornotate sock oft)e applce{tut l«hcn the ai"plict+n( rs a :orporation), _ -li)the lugal or beneficial owner of any Int'-t:51 rn a non-cutporre entity(when the applicant is not a corporution), an ofli:er,director,partner,nr employee of the appliran';or _---D)the actual applican(. UFSC RIPTIUN OF RELATIONS]iii' Submitted this _day of. Signature`., Form Z'S 1 Print Name APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM The ToyM ofS uthold's Code of Ethics prohibits conflicts of interest on the part oftown,bfficc s and employees.Tl e ou a e of this form is to provide information which can alert the town of possible conflicts of interest and allow it to take whatever action is necessary to avoid same. YOUR NAME: &JH,4 C le (Last name,first name,.ipiddle 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(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,iparriage,or business interest_"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agendreprescntative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town otficei or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this JZday f zr 20Y Z f Signature Print Name Form TS 1 Town of Southold LWRP CONSISTENCY ASSESSMENT FORM A. INSTRUCTIONS 1. All applicants for permits* including Town of Southold agencies, shall complete this CCAF for proposed actions that are subject to the Town of Southold Waterfront Consistency Review Law. This assessment is intended to supplement other information used by a Town of Southold agency in making a determination of consistency. *Except minor exempt actions including Building Permits and other ministerial permits not located within the Coastal Erosion Hazard Area. 2. Before answering the questions in Section C, the preparer of this form should review the exempt minor action list, policies and explanations of each policy contained in the Town of Southold. Local Waterfront Revitalization Program. A proposed action will be evaluated as to its significant beneficial and adverse effects upon the coastal area(which includes all of Southold Town) 3. If any question in Section C on this form is answered "yes" or "no", then the proposed action will affect the achievement of the LWRP policy standards and conditions contained in the consistency review law. Thus, each answer must be explained in detail, listing both supporting and non- supporting facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,it shall not be undertaken. A copy of the LWRP is available in the following places: online at the Town of Southold's website (southoldtown.northfork.net), the Board of Trustees Office, the Planning Department, all local libraries and the Town Clerk's office. B. DESCRIPTION OF SITE AND PROPOSED ACTION SCTM# PROJECT NAME The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. F-1Board 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: Alwvx. Iz *PR ol;� ae4AE (6, Igo S�r-;7-) vv1,,4 _ I ;f2t;o� ?pR,46-HIr,,Es A,e, Location of action: /®®6 �'� ®p�[,��/!, J_Vr 6� ,vy ��9�✓ Site acreage: Present land use: —IAA, OAAE 6gH11- Present zoning classification: k-4 p 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: STV L&-A& O UI-�A 1Q-/6Z0DW.W (b) Mailing address: � � w�rj�� D)/ f� ,may �'D V2. ' ZZ (c) Telephone number: Area Code( ) R,6 6 97-- .:?&-17 (d) Application number,if any: Will the action bbe( directly undertaken,require funding, or approval by a state or federal agency? Yes F-1No�J If yes,which state or federal agency? C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED COAST POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure, makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. I/1 Yes ❑ No Not Applicable Or G--e Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria ❑ Yes ❑ No 9 Not Applicable G iv Q 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—PoliciesPages8 through 16 for evaluation criteria ❑ Yes F1 No No 1� Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of.Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No ®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. ❑ 7 9 l Z � 1 f - r Yes No Not Applicable -- R641C y G Av/ 7-6 des Plze cr� Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ No® Not Applicable Attach additional sheets if necessary Policy S. Minimize environmental degradation in Town of Southold from solid waste and hazardous substances and wastes. See LWRP Section III—Policies; Pages 34 through 38 for evaluation criteria. ❑ Yes ❑ No 9 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. ❑ Ye0 1140,W/1 Not Applicable A Oe U 0 CCS L Attach additional sheets if necessary .,i WORHINC COAST POLICIES Policy 10. Protect Southold's water-dependent uses and promote siting of new water-dependent uses in suitable locations. See LWRP Section III—Policies; Pages 47 through 56 for evaluation criteria. ❑ Yes ❑ No g Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconie Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No Z Not Applicable Attach additional sheets if necessary Policy 12. Protect agricultural lands in the Town of Southold. See LWRP Section III — Policies; Pages 62 through 65 for evaluation criteria. ❑ Yes ❑ No Lont1 Not Applicable Al Q 04(2Z,4 w,ns off/ a0y o2 a&7- &►s "o AF7 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 ❑ NoX Not Applicable ! 2VA )V � ls' P�o>7�cT PREPARED BY /J�A. L�,4CZ TITLE_ AG,,rvP` DATEh?l��