Loading...
HomeMy WebLinkAboutTR-9958A DiSalvo, Diane From: Brian Noll <bnoll@molloy.edu> Sent: Wednesday, August 18, 2021 1:41 PM To: DiSalvo, Diane Subject: Re: Missing page - LWRP Ms. DiSalvo, One of the Trustees spoke with me this afternoon on the phone. He discussed the woodchip path with the other members of the Board and they agreed that it would not be permissible. He recommended that I contact you to have this portion of the permit request removed but to leave the pruning and tree removal on, which they did not have a problem with. Please let this email suffice as authorization to remove this from the permit application. Thank you, Brian Noll ® EEGA E0V Brian Noll Assistant Professor AUG 18 2021 School of Business Molloy College 1000 Hempstead Avenue Southold Town Rockville Centre, NY 11571 Board of Trustees 516.323.3093 bnoll@molloy.edu From: DiSalvo, Diane<diane.disaivo@town.southold.ny.us> Sent:Tuesday,July 6, 20213:03 PM To: Brian Noll<bnoll@molloy.edu> Subject: Missing page- LWRP - ---ter -� ;r �-77MI—'c',.,'_ r`" -.- ... a" '• s�k1;S,...,i�, -'• F _. f." ' �,.� 1Y`d;,�,,,{' lThis message originated'outside of Molloy,;College,•©o,:not;click.,links,or-opens attachments-,unless you,,are'sure'the'conten Please fill out, sign and email back to me. Thank You D%G V"e DiSnLvo SOutkoLd Towv,. Trustees '54 S7,5 Tokte 25 P.o. gox zz79 Sokthal ' N`( 119 j 1 (C,32) j 65-18 2 (C'3 ) ���� Glenn Goldsmith,Presidento��OF l 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 �y�OU01 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9958A Date of Receipt of Application: July 6, 2021 Applicant: Brian & Barbara Noll Project Location: 450 Maple Avenue, Mattituck Date of Resolution/Issuance: August 18, 2021 Date of Expiration: August 18, 2023 _Reviewed __Glenn Goldsmith, President Project Description: As-built removal of one (1) dead tree, to prune trees. Findings: The project meets all the requirements for issuance of an Administrative Permit set forth in Chapter 275:of the,Southold.-Town Code.The issuance-of an Administrative Permit allows for the operations as indicated on the project plan prepared by Brian Noll, received on July 6, 2021, and stamped approved on August 18, 2021. Special Conditions: None. Inspections: Final Inspection. If the proposed activities do not meet the requirements for issuance of an Administrative Permit set forth in Chapter 275 of the Southold Town Code, a Wetland Permit will be required. This is not a"determination from any other agency. Glenn Goldsmith, President Board of Trustees S.C.T.M.# DISTRICT 1000 SECTION 107 BLOCK 3 LOT 4.1 r , UP 165.91' v�Pc - 6 202 up 7 N t� 3B°'' Southold Tow Board of Truste d 4 uo F srr Fxwr amuxc Faa " a.Y } Wxc.wW �' FIPE Tin9jY,L "a W�Epl9°� � FFPE �yMU� O PPE *\ LAND N/F OF THOMAS CAHILL rz� ` FlPE 1 1 �J LAND N F OF JOHN ALFIERI ; V Y '80ARD"OF "I RUSTEES is TgWNr,OC ,'SOUTHOLD DATE,- A-utrccsi ivi 2ozj .L 4151 - ,..R B{,441' 5755450 I YIT'W AREA 80,472 SO FT or 1.85 ACRES Etcvancw DATUM UNAUMLWI ALR AnM DR ADDIRON M MIS SURIkY IS A WMIo FY'SECRCN!]209 LP-MENEW YORK STA)E EOUG TIOV LAW COPIES G"IN's suFw E00Ei 41 E oe �'Y MAP NO(HEARING ME UND SURLEYOR'S EMBOSSED SELL SHALL NO(BE LDNSIDERED fa BE A VAUD TRUE COPY OVARANMrS WDICA RTI HEREON SHALL RUN E9`pM1V'y$.`' YY oon/TO WE HEREON,EHANO ro E A59CNEES PW WE LENOINCED AND NTI N HIS MWALLEES ARE ND TRANSFERABLE GOWRNNEN(AL ACENCY AND To MUNUON lr aFP pf IME OFFSETS OR O'MENAONS SNONN HEREON FR DU INE PROPERTY FINES TD NE SMCNRES ARE FOR A SFEOM PURPOSE ANO USE IHEREFYARE MEY ARE v Y Nor INTENDED N NDNUYENT ME PRLVERIY ONES OR N Q XC IHC ERECTION OF FENCES ADDITIONAL S—TURES OR AND OMER WP WMENTS EASEMENTS AND/M SUBSURFACE SIRUCNRES REL DED CA UNRECORDED ARE ND(OVARANIEED UNLESS PRMCALLY ENDEN(ON ME PRE'IIFSES Ar ME WE Or SURVEY g 4 OV SURVEY OF DESCRIBED PROPERTY CERTIFIED TO BRIAN NO L. BARBARA NOLL, Y YAP or FIDELITY NATIONAL TITLE INSURANCE I FILM SERVICES, LLC, STUATED AT MATTITUCK CITIZENS BANK, N A. / rowN OF SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY,NEW YORK y Prof".....land Survejr-g end D—g. THE WA RF SUPPLY,WELLSI,DRYWELLS AND CESSPOOL lry P 0.Box 153 Aquebague,New York 11931 LOCARMS SHOWN ARE FRDV FIELD OBSERVAWpVS Glenn Goldsm 'President �p� � Town Hall Annex A. Nicholas r\rupski, Vice-President 54375 Route 25 John M. Bredemeyer, III .�� P.O. Box 1179 cz Michael J. Domino * ,�,, Southold, NY 11971 Greg Williams %o5 Telephone (631) 765-1892 ly Fax (631) 765-6641 BOA" ur iuwn tnu�iEES TOWN OF SOUTHOLD Date/Time: 9116121 9.' L5 Completed in field by: (a, (�„�dS►� BRIAN & BARBARA NOLL request an Administrative Permit for the as-built removal of one (1) dead tree, to prune trees and to create a 4'x25' woodchip access path. Located: 450 Maple Avenue, Mattituck. SCTM#: 1000-107-3-4.1 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: 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: I have read & acknowledged the foregoing Trustees comments: Agent/Owner: /G. Present were: J. Bredemeyer M. Domino Goldsmith N. Krupski G. Williams Other S.C.T.M.# DISTRICT 1000 SECTION 107 BLOCK 3 LOT 4. 1 - - - - — „�• ESE . i — - AvE U.P. 16591' PIPE MA — pLE ROA P � o � N OKK o U.P. o `? CT � 38�•�� DRAIN '1�u' f..� :::.358::•::•::•:•::•::'::•:•: ✓ N ............. ::: W.- ............ O� ,:•:•::•. .RAG.....:':::•: 52.2 d2X ovEs ::::::. ... ..:.....:'::: 9.0 ::::::::::::. • o 10.9.w ..2p.5::•:::•::::•a'9• WELI ............... :: ::::::•::;....:.. PATIO ®PIT ii{•ii::i•:ii:'::.:f STY FRAME':yi:•i::- id ::'DWELLING N450•::::•:::•:: : : .`'.:.Y4•ti :::: ::: X13 3' PIPE :::: GR► C 8.1 �}1 •:•.14.9':::• w. o; :;:•::� �'.•:•.. � DECK 1?j 9 ''' • PIPE DECK ON GRA NoNK 410E M.H. O PIPE LAND N/F OF \� THOMAS CAHILL PIPE x Southold Town \ Board of Trustees -f LAND N/F OF / JOHN ALFIERI F 1 ` ' l t sum, C,,✓ tWo � .� ' QV)o 00, --�� 28.41' S'554�. .,, N 84'4627- W co o cqAREA: 80,472 SQ.FT. or 1.85 ACRES ELEVATION DATUM. UNAUTHORIZED ALTERA710M OR ADDITION TO THIS SURVEY IS A V40LA77ON OF SECTION 7209 OF THE NEW YORK STATE EDUCA71ON LAW. COPIES OF THIS SURVEY �' 9h� • ti Pyo �i� 6 MAP NOT BEARING THE LAND SURVEYORS EMBOSSED SEAL SHALL NOT BE CONSIDERED TO BE A VALID TRUE COPY. GUARANTEES INDICATED HEREON SHALL RUN �0�� V00 ONLY TO THE PERSON FOR WHOM 774E SURVEY IS PREPARED AND ON HIS BEHALF TO THE 777LE COMPANY, GOVERNMENTAL AGENCY AND LENDING IMS7I7U7701V LISTED HEREON, AND TO THE ASSIGNEES OF THE LENDING INSTITUTION, GUARANTEES ARE NOT TRANSFERABLE. THE OFFSETS OR DIMENSIONS SHOWN HEREON FROM THE PROPERTY LINES TO THE STRUCTURES ARE FOR A SPECIFIC PURPOSE AND USE THEREFORE THEY ARE NOT INTENDED TO MONUMENT THE PROPERTY LINES OR TO GUIDE THE EREC77ON OF FENCES, ADD17701VAL STRUCTURES OR AND OTHER IMPROVEMENTS EASEMENTS +� AND/OR SUBSURFACE STRUCTURES RECORDED OR UNRECORDED ARE NOT GUARANTEED UNLESS PHYSICALLY E14DENT ON THE PREMISES AT THE TIME OF SURVEY Shy O SURVEY OF:DESCRIBED PROPERTY CERTIFIED TO: BRIAN NOLL; BARBARA NOLL; MAP OF: FIDELITY NATIONAL TITLE INSURANCE FILED: SERVICES, LLC; SITUATED AT: MATTITUCK CITIZENS BANK, N.A.; / TOWN OF:SOUTHOLD KENNETH M WOYCHUK LAND SURVEYING, PLLC SUFFOLK COUNTY, NEW YORK y� f, Professional Land Surveying and Design 774E WATER SUPPLY, WELLS, DRYWELLS AND CESSPOOL +G P.O. Box 153 Aquebogue, New York 11931 LOCATIONS SHOWN ARE FROM f1ELD OBSERVATIONS FILE N 220-94 SCALE: 1"=30' DATE:AUG. 15, 2020N.Y.S LISC. NO. 050882 PHONE (831)298-1588 FAX (631) 298-1588 AND OR DATA OBTAINED FROM OTHERS t i � -\�� ..'R►'�x� �• .L 4� 1�,�1��._ryiJ{. � r i�. _ �.T .�1�'�����i�f"J`���i J r r UP) W9fr i • r - • iuyli�ll�/Y�f/LAyrw�rlw,�y'�!.y.�r QItY�!Mi. _ ,,•..rwri+,^.' {u 1 4 11�i Ar �{'A 1 t $I- •r+•Lyi,'i"� �� 'rf OVA vvvvo oft T>- loo • I � 1 O6,I Ye x pF2so] �_ l�� SEE 8EG NO.tm 8H 8�.1q.tm AW NTa.a. LYpn a'S MnTG, 1111E WVCII VIE xT m.MW j Pp' l 14 t-]oW p♦ _ t]P(cl rCO1MVOYlYe 2°w SEES I.MD. z 13-0teo - tMoeYlrt�tta e.] 61]t M\\.' atTsanENrnrrrrsl " LI � ut auE OLa00a " 60e 000f0O nYsr mrrvr mrxrsr 04 tto- m 1 2— E 22w NLa s m t Ilam / e M1B a,M1 e e to. M-412 -4 / ( � � ? ) 0 ) rtrEloNzn Nrnn " 0M 21L tW� �0E.0VINd0 a-u1e \ cP a.� Im 2 e \ IA � E M11 2u 5N sfE 8 � ,iHcl 'C ep `)y. 1. 6) 14 '" ,�, Q• b ���m� I' ♦) E � tsWq mnmrzNrreona] I s d .sem\ mwwa 1 � l I: f1 &0 Nd) s \.� f e ♦a � w.+ sae 3f 7 / tae z\ �" �� 9 � � ♦01♦ � twycl ♦ a ` � tn.e° qi ` : ♦♦ 1• •� e N d nA � O r aA # � ♦1 ��� 9 T y ♦) 2W4 � /: 3 ♦ t w � rpt°cl1q. / M1 '4 f♦♦d t1 P ♦e % t ' . `d'�n 5L w SEE OEC.W.r14 •1♦ Y a 32 r d, • K, , d Ql9' n 8H BEC.11D. �5 'Lo t♦ 'N nP A � M.1 I A o _� �'�,' ���,�n 02 � uAV4 �/ 1ts0)0o12 ° ♦° M1• ♦5 W t° g_w e.♦`, I W mztu�N.rounar S X14 .+ � ♦° ♦e♦. T p 9 \ A r z>r ar= ♦5M!�... __ yrR e r� f •(70 N twrol 1alE tp � d � O- vtweew stn E �" R1 = — -- �u egncE COUNTY OF SUFFOLK © e WM1101D SEC 110N NO Real Properly Tax Service Agency v H - --- s.� ._� No qS m A 114w 1M0 it Hy raorEaTr euv OFFICE LOCATION: a SO!/ry® MAILING ADDRESS: Town Hall Annex P.O. Box 1179 54375 State Route 25 Southold, NY 11971 (cor.Main Rd. &Youngs Ave.) ANC Southold, NY 11971 ® Telephone: 631765-1938 c4UNT`I,�� 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 BRIAN & BARBARA NOLL SCTM# 1000-107-3-4.1 BRIAN & BARBARA NOLL',request,an Administrative Permit fors the'as-built removal°df one (1) dead tree, to prune trees and to create a 4'x25' woodchip access path. Located: 450 Maple Avenue, Mattituck SCTM#: 1000-107-3-4.1 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 action is INCONSISTENT with Policy Standards and therefore is INCONSISTENT.with the , LWRP. Policy 6. Protect and restore the quality and function of the Town of Southold ecosystem 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 9. Comply with Trustee regulations and recommendations as set forth in Trustee permit conditions The work was performed without obtaining a Wetlands Permit. 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 NARRATIVE TO ACCOMPANY ADMINISTRATIVE WETLAND PERMIT 450 Maple Lane(Avenue) Mattituck, NY 11952 Applicants: Brian and Barbara Noll 0ctober'2020-CaRe 'the dDepartm t ofxEnvironmental CoriserVatiori'(DEC) Called the Department of Environmental Conservation (DEC). Spoke with Darlene Defabio @ (631)444-0295. Discussed removing a dead tree approximately 90 feet from the mean high-water line. Also discussed pruning of several trees of dead limbs and the establishment of a path of wood chips to allow access to creek for kayaks. She commented this this should not be a problem. She commented that the full clearing of a property that is 300 feet from the water is a problem and is not permitted. November 2020—Removal of Dead Tree, Pruning of Trees Removed dead tree approximately 90 feet from mean high-water line. Pruned trees whereby most trees had dead limbs on property, and several were within 100 feet from mean high -water line. Cutup large sections of trees for firewood and chipped all limbs that were cut. Moved pile of wood chips via wheelbarrows to 10 feet from mean high water line to establish path to allow access to creek. February 2021-Placement of Woodchips Moved woodchips via wheelbarrow on wetlands to establish 4-foot-wide access path to creek shoreline. May 1,2021-Receipt of Ticket-Summons B0074 Met with Bay Constable Officer Joseph O'Leary. Received ticket for court appearance. Ticket claims "move dirt, cut and prune trees in wetland area without first obtaining a permit." Please note that NO DIRT WAS MOVED... ONLY WOODCHIPS WERE MOVED. This can be evidenced by the inspection of property. May 20,2021-Applied for Wetland Work Permit Applied for permit along with fee for removal of a tree, pruning of limbs, and establishment of path in wetland area (within 100 feet from mean high water line). As per Diane of the Town of Southold at(631) 765-1892,we should determine from court appearance what is necessary as this is an "after the fact" action. June 16,2021-Court Date Pleaded not guilty to Summons 80074. Per discussion with Mr. Damon Hagan,Assistant Attorney for Town of Southold, an application for an Administrative Permit should be requested for the removal of the dead tree, pruning of limbs, and for the access path made of woodchips as per Section 275-11-10 of the Town Code. As part of this discussion, I reviewed the details and dates in this narrative along with the survey. June 28,2021 Measured 100 feet from mean high water line with 4 ft reflective plastic stakes and marked where tree was removed (90 feet from mean high water line)with an orange construction cone. r Cu CIV C D i- I jut Sout of Town Board of Trustees Glenn Goldsmith, President a soo' ; Town Hall Annex A. Nicholas Krupski,Vice President �,,� ���� 54375 Route 25 t P.O. Box 1179 John M.Bredemeyer III ,``,;,, ` Southold, New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams �, _ Y Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only (� ((�� Coastal Erosion Permit Application ® E C E yin 0 V E Wetland Permit Application Administrative Permit Amendment/Transfer/Extension JUL Received Application: 7•&ZI Received Fee: $ 100.00 Completed Application: (vZ Southold Town Board of Trustees Incomplete: SEQRA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: �Xoordination:(date sent): 6 LWRP Consistency Assessment Form Sent: CAC Referral Sent: yDate of Inspection:_ Receipt of CAC Report: Technical Review:- ,,-Technical Hearing Held: Resolution: Owner(s) Legal Name of Property(as shown on Deed): �l��.n RN� '� �✓ Mailing Address: )t t/t n I �� 11 -1��"� i Tyr kry. 1 � Phone Number:( 1 °_q d - 010("' Suffolk County Tax Map Number: 1000 - se-c- -ox) 10-7 61 ock 5 , La� 70 Property Location: q6O Md1 e— &fA/V6 L�✓✓� 1 /0/?-t �Vt,� • �. QI 'j! 5 d — (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): Mailing Address: Phone Number: (04,1141 Board of Trustees Applicz, :)n GENERAL DATA r Land Area(in square feet): yJ 61 Area Zoning: S' Previous use of property: Intended use of property: Covenants and Restrictions on property? Yes _,XNo If"Yes", please provide a copy. XNo Will this project require a Building Permit as per Town Code? Yes If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes __><No If"Yes", please provide copy of decision. Will this project requ e y demolition as per Town Code or as determined by the Building Dept.? Yes o 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 Desc iption (use attachments if necessary): 4.'v -s 1 Board of Trustees Applici-,� on WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: vlo/1&- / 0/— "I r-cvr uvioe_ ACQ5 Wo D P 5j Area of wetlands on lot: square feet Percent coverage of lot: % Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: feet L0 Does the project involve excavation or filling? No �r ',,,p� Yes If yes, how much material will be excavated? AVA cubic yards Woo Dw/P How much material will be filled? cubic yards Depth of which material will be removed or deposited: feet f'/ Proposed slope throughout the area of operations: Manner in which material will be removed or deposited: VN 1/�'fz 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 Sizort Environmental Assessment Form Instructions for Completing Part l -Project Information. The applicant or project sponsor is responsible for the completion of Part 1. Responses become part of the application for approval or funding,are subject to public review,and may be subject to further verification. Complete Part I based on information currently available. If additional research or investigation would be needed to fully respond to any item,please answer as thoroughly as possible based on current information. Complete all items in Part 1. You may also provide any additional information which you believe will be needed by or useful to the lead agency;attach additional pages as necessary to supplement any item. Part I -Project and Sponsor Information Name of Action or Prcject: Rd,,,' P Project Location(describe,and attach a location map): q�-o MApl,(_ [/7,4� A Tf-/ Al V Brief Description of Proposed Action; 1) J/ S PSL �✓,�ci"L G� �� /Yl �S �CLCss ��`� �'/ �✓'� 1�1�dGrG�i���' i Name of pplic,4nt or S onsor: Telephon /-'6 �p . SE-Mail: Address: City/PO: � r State:, l Zip Code: 3� 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 may be affected in the municipality and proceed to Part 2. 1f 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: a 3.a.Total acreage of the site of the proposed action? m 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 1 of 4 5. Is the proposed action, NO YES N/A a. A permitted use under the zoning regulations? ❑ b. Consistent with the adopted comprehensive plan? ❑ 6. Is the proposed action consistent with the predominant character of the existing built or natural NO YES landscape? 7. Is the site of the proposed action located in,or does it adjoin,a state listed Critical Environmental Area? NO YES If Yes,identify: j_NV 1✓1' ❑- 8. a.Will the proposed action result in a substantial increase in traffic above present levels? NO YES b.Are public transportation service(s)available at or near the site of the proposed action? ❑ c.Are any pedestrian accommodations or bicycle routes available on or near site of the proposed action? 9.Does the proposed action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,describe design features and technologies: 10. Will the proposed action connect to an existing public/private water supply? NO YES 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? b.Would the proposed action physically alter,or encroach into,any existing wetland or waterbody? If Yes,identify the wetland or waterbody and extent of alterations in square feet or acres: El R 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply: ❑Shoreline El Forest ❑Agricultural/grasslands ❑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? CR 0 16.Is the project site located in the 100 year flood plain? IVIIA NO YES 17.Will the proposed action create storm water discharge,either from point or non-point sources? NO YES If Yes, /)j ❑ a a.Will storm water discharges flow to adjacent properties? ❑NO YES , r b.Will storm water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: E]NO AYES Page 2 of 4 18. Does the proposed action include construction or other activities that result in the impoundment of NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: o ❑ 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: ❑l ❑ 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 E BEST OF MY KNOWLEDGE A;01/ Applicant/sponsor arae: �• �� ®t Ii Date: Signature: Part 2-Impact Assessment. The Lead Agency is responsible for the completion of Part 2. Answer all of the following questions in Part 2 using the information contained in Part 1 and other materials submitted by the project sponsor or otherwise available to the reviewer. When answering the questions the reviewer should be guided by the concept"Have my responses been reasonable considering the scale and context of the proposed action?" No,or Moderate small to large impact impact may may occur occur 1. Will the proposed action create a material conflict with an adopted land use plan or zoning El ❑ 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)? 5. Will the proposed action result in an adverse change in the existing level of traffic or El 1:1affect existing infrastructure for mass transit,biking or walkway? 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? 7. Will the proposed action impact existing: ❑ ❑ a.public/private water supplies? b.public/private wastewater treatment utilities? ❑ Q 8. Will the proposed action impair the character or quality of important historic,archaeological, ❑ i❑ 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)? �J 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 M El problems? 11. Will the proposed action create a hazard to environmental resources or human health? El El 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-tern,long-term and cumulative impacts. (� Check this box if you have determined,based on the information and analysis above,and any supporting documentation, I-1 that the proposed action may result in one or more potentially large or significant adverse impacts and an environmental impact statement is required. 1__.1 Check this box if you have determined,based on the information and analysis above,and any supporting documentation, that the proposed action will not result in any significant adverse environmental impacts. Town of Southold-Board of Trustees Name of Lead Agency Date President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer Signature of Responsible Officer in Lead Agency Signature of Preparer(if different from Responsible Officer) PRINT Page 4 of 4 \ Board of Trustees Appla.ca', ->n AFFIDAVIT BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMIT(S) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF, AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S), IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES, THEIR AGENT(S) OR REPRESENTATIVES, INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner Signature of Property Owner SWORN TO BEFORE ME THIS DAY OF , 20 y2 o a ublic LIAUREEPI to MACKEN?lE wagy Public, Mato of Mr ri York 0 (,44 rf 7 tic. 90.4747235 ILC c!ualltled to Suffc;lx ccura;Y mra piie� laam v�o V ~` ^ ^ .. ^ `^ DISCLOSURE,TRANSACTIONAL FORM ,this fbnn is to vrovid&inforinaflon'which can I alert th,�town,of ibje conflicts a 1joe Mud ion is YOUR NAME: (Last name,first ri�aikie,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 0FAPPLICATION: (Check all that applyj ' Tux grievance ____— uounmg Variance ______ /ousteo Change of Zone _~ _ Coastal8msioo Approval nfplat - M» ring _----- Exemption from plat or official map Planning Other 46 (If^`Odboe',name the ac/ivit^) fid/h, Doyou personally(orthromgh your company,spouse,sibling,parent,orchild)have urelationship vithmnyofficermemployee nCthe Town ofSouthold? "Relationship"includes by blood,niarriageerhusinosnloterest-~Busin,o interest"means ubusiness, . including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation inwhich the town officer vremployee owns more than j%ofthe shares. YES _______ NO —X--- If __X--_ |[yuuononen`d^^Y8S'`,comp|ote,hohu|omono[tbioDoonuoddateoodoignnbenoiod|cumd. Name ofperson employed hythe Town ofSouthold Title orposition o[that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer oremployee.Either check the appropriate line AJthrough D)and/or describe iothe space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that opph/): the owner ofgreater than 5Y4o[the shares ofthe corporate stock of the applicant . (when the applicant is a corporation); the legal orbeacfioiu|owner ofany interest inunon-corporate entity(when the applicant isnot moocporation); unofficer,director,partner,nr employee o[the applicant;nr . the actual applicant. DESCRIPTION OF RELATIONSHIP . . °� A . thisJLay of- Sipatttre � Print Name . FmrmISl oil , \ ' 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. 2.1 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 si_gnific_an_ t beneficial and adverse effects upon the coastaf area(which includes all of Southold Town) Y 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- supportin1�facts. If an action cannot be certified as consistent with the LWRP policy standards and conditions,�it shall_notbe 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 (,� �S i UK- i Y�o MAP The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees 1. Category of Town of Southold agency action(check appropriate response): (a) Action undertaken directly by Town agency(e.g. capital ❑ construction,planning activity, agency regulation,'land transaction) (b) Financial assistance(e.g. grant,loan, subsidy) (c) Permit, approval, license,certification: Nature and extent of action: V41 o� IU-e,- CS P/L, a�- 1, M4 5 0O C�' A Location of action: `7 So AA t6v ���/✓� / i �- Site acreage: C Present land use: P � Present zoning classification: S % ✓� 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: p� (a) Name of applicant: Molt Z&' "e r (b) Mailing address: k'A11-W C/ 11530 (c) Telephone number: Area Code( %O 0 I0 ,6 (d) Application number, if any: Will the action be directly undertaken,require finding, or approval by a state or federal agency? Yes El Nol�ie— 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 eva"lei on criteria. -Yes No ❑ Not Applicable C Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LMW Section III—Policies Pages 3 through 6 for evaluation criteria ' Yes 1:1 No ❑ Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria Yes ❑ No ❑ 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 LWPjP Section III—Policies Pages S through 16 for evaluation criteria( Yes ` , leo ❑ 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 LJ 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. ❑ ❑ Yes No Noy applicable Attach additional sheets if necessary Policy 7. Protect and improve air quality in the Town of Southold. See LWRP Section III — Policies Pages 32 through 34 for evaluation criteria. Ix YesF] No❑ Not Applicable Attach additional sheets if necessary Policy 8. Minimize environmental degradation in 'Town of Southold from solid waste and hazardous substances and wastes. See LVW Section III—Policies; Pages 34 through 38 for evaluation criteria. 04 es ❑� 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. C2f YO No❑ Not Applicable Ids 040� ~ PAPY C C eSS- 7-0 5�r/lJi'A/e-- 6 Attach additional sheets if necessary , .�:,p��,,grv{.°y�,j���_� ��+2��x*•ii 'ia*"s=���'� �; •�, ,��,x •� «. yo-. � ;�.�� r '�.'"w�'¢' ' •a'i,';% ;'LrC��S'.'�.�'L;"�W�``�� �'`"y�°7���-, �w `;'���7�;r�'�*,r ��+ y�� a�.�: '- _�` ,r „ ,.'�. ."`,r-�,.� z�.Y4.„•, h rj.4;,'x .,: $�;¢9re.° Ty�:,:`� _'� 3�_:��'�, tiioId!3-w�.`,• w"�r. Pmio ��0.L'rote s=ri�� er_�Se eIIt c its "at rtr m l - - tom'-..ciA �• �'.4YY(y{i* -,J.��T;S,e:r'^. �e. k �^ ,� p: 1l��Ji.^�}�•-et�:sJ�.x � �,` t ���j�IC���� ;a; »,.... ;�w,u��ao '� ,, <Pt�,�,<tR�ry`"`�u''S';'' � k' � � •SF,. .x � �.. snn �s..4,-;���t`�r��"`n '#,�.."„�`;^�;" ash° ''"_,�,ra��' , - - - - - -- - �3�e" ,���a #��wtY`-�hnars.� .•�Y4;xe„x,�= '*'r:-�-, v`�� ""¢,�- �' "" -�`r',+ — -- - - - —_ ...�-..-__•�,�.�-».yam...,,..-,xa�a.:„x^.,FG,.r:Pr*.�.�„ ••�:.�_;.,a,,`.'r,..�^.�..^:-;;�`�,, .n,y� �.rw �,. ,l . � '`;:`>' L `f..y]Sf°�yx� tr�T.,AL�`'�"`� `�'�ti i'`£.- "'iP"-S” � -"h"rx'�'`�,•`•�' .y.&�"q.,M, �' yy4��s `��. . r> ,. . - 4k;..w•:�'�4'"�•�t%"�aF,"'3."a'°^3' ,r^�,,„` :� �^�' �.z r^ '�Z'�`e.�"+kae.�� . gF1v, _ _ _ _ -• - _ -' •;: ,. 'sN:.,�-_ ,'""'i ';'ry,tdkfi,-'sa Ex�3z,.,.zx „=Vii:a,i ;n; _ • 1iLicb� titia_nalslieetsinecessary '''. ZO i r �'<• _ =!': - a"ctc x..F^M ""- 5 .±3xxy ps„n.�.. 'I.- "-':,„'€A y' �,w "d�ir � ... �,`",+�` . -.,�..,'' ��R",: 'F.�s fl,`yy�` °ir'w`t:" acs ."„.Y� � ._.>•i"a - 'toali`ote sus � ileA`rtis • irl' � rine resource ;w,Y;eng,.?.�Tslau� _ � �� ,- -_ _ a - - 7., �C',-, _:e;:' Y' - -Y}5�..: :.�""`kK�._F'�t'�.�.:.��„�'$•�s;r yp'�„.�°°'``:tr:,."�'." '�'�:� `�'a ;'inar ;aln o %n wags.See)v IZP� e hon II � 'ohe�es� a es 5 `through 62,fox,�evaluation R a F a t,•`•r' „,;•w ySIT ''_ ; -_'-. QCT � 1 Oe rr`7pe4� � .max.. �T`�'�°�a . t'_ AM1a� + `� .•:ri"`� F t•st i'« ,�+,r•'-,� „u e,t r.�= - -, " �>_.- - ,-_. �..v... _ ,...-- -• _' -- :,c �x�•r SFS - - fps ,.. '�,� •,•. -- • '[Rb'liey 32.. Project agriCulhii-AAA-land aAn the Towi -O SWithold. S&Il"-' S_ectldm,.M-;A'olid;* Pages'. &2 tlaroi� d .tifore�raluafiute cxatrAa:, o -ate�t: Yry^F„ - , �' '?,° ✓; .. �� r,}�,�_����-< n �k�i'� �;�C Al G1,G,�=tet S, .-„at=.Y' :- _ �- ,�� _,��.ni,-`c,..w�.�. � i„"Ycro<_ ;. • fix, '`;�' war=;. ••� „�.a•, .;y^,. _ ,�aa, ``� :> ," `,� ,.CM �+n��¢ ,,- - .,fprAb`k,`�t`hG�'<=`,fs 4d .Q.. - '"''�`�"?.v -_ - v�`�=.- - _,. u•,t.�r�::,"rz 71, + ttiiCllttl7iitmal$hc ets 11Eiones aly 3 ,, ,,. ;•xt .^;:_ . ,: .`. 'roauot app ops-iiite use 'aa d development of energy, and mincril='rkesources<:`See Ji ItP ' 44M ` e�tiort ]Policies; ?ages't;� through 68-ffor,evoyonti-o i,criteria�,i N pp77 A t ot le lr TITLE i� J➢� t .•�rirrr ' I21�1'AREi P I�ATI