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HomeMy WebLinkAboutTR-9998A Glenn Goldsmith, President �Qf SD(/Ty Town Hall Annex A. Nicholas Krupski,Vice President ,`OOl0 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 �O �� Fax(631) 765-6641 �y00UNT`I,Nc� 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 _ P.re,CIOnstructi&-'hay bale:Jine/silt boom/silt curtain ", nstrucfed., , Wkieri.project cornp'lete,-calf for compliance inspection; Glenn Goldsmith,President SO Town Hall Annex A. Nicholas Krupski,Vice President ,`O l0 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 9998A Date of.Receipt of Application: Septembers 24, 2021 Applicant: 2500 Grathwohl Rd. LLC SCTM#: 1000-117-1-3 Project Location: 2455 Grathwohl Road, New Suffolk Date of Resolution/Issuance: October 20, 2021 Date of Expiration: October 20,,2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed and to remove poison ivy. 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 Patrick McAuliffe, received on September 24, 2021, and stamped approved on October 20, 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. 41— Glenn Goldsmith, President Board of Trustees ' ---- -- - --- - --- - -- - - --- - -- - - - - THE EXISTENCE OF RIGHTS-OF WAY UNAUTHORIZED ALTERATION OR ADDITION DRAWN NN QUO NN DATE NOV. 2OtS DRAWING JOB ND. �S-��HCJ AND/OR EASEMENTS OF RECORD IF TO THIS SURVEY IS A VIOLATION OF ANY, NOT SHOWN ARE NOT SECTION 7209 OF THE NEW YORK-STATE GUARANTEED. EDUCATION LAW. �- COPIES OF THIS SURVEY MAP NOT BEARING S13®21 X00" ` EMBOTHE ISSED SEAL SOHALL INKED BE CONSIDERED 2? I"00, E whinTO BE A VAUD TRUE COPY. i RO GUARANTEES INDICATED HEREON SHALL RUN �a f ONLY TO THE PERSON FOR WHOM THE SURVEY p% IS PREPARED, AND ON HIS BEHALF TO THE �(A ! TITLE COMPANY, GOVERNMENTAL AGENCY AND � m S�3° � LEING TION LISTED HEREON, AND ASSIGNEES OF THE LENDING INSTI- r W ba �t 2 DO„E TUTION. GUARANTEES ARE NOT TRANSFERABLE. 00 pe� 4 °fes metere"'e�t�� Tax LOt O known as: °Q�19 0°t-, ' o Areo Eaj T C0T 10 ” 2500 Grathwohl Road, New Suffolk W o 160 6 5.39• 8' g s f. ------ �' rC/) oco o (� E0VE or a z ` „� a Z - � �� e� D p 49.1' 1�2 Op' r r k - �,� :3 SEP 2 4 202,1 3 gi,n-(rpm _ - O �' - -- _ - ' , �, _ • `i N b y a' N73' 0 r "M Southold Town r 2J'A�N� FQurror" • ` `Y , . Board of Trustee - ,` 9� - - - 0 off �o g 0 d�w°Jr torr�rp9 ' • face s•'S - _ - - ,c -.- co ?O'}�p ge 8�, 00 0 Survey of Described Propertiesa, 2, o _ a situate at r N.73 12-2' �^ cS'F J� LAND New Suffolk POte l Town of Southold Suffolk County, New York APPROVE Y District 1000 Section 117 Block 1 Lot 3 & YCertified to: BOARD ®F `�t�USTEEs Michael W. Minto, L.S.P. C. TOV ROF. SOUTH®LD District 1000 Section 117 Block 2 Lot 10 JENNIFER FOLEY LICENSED PROFESSIONAL LAND SURVEYOR PATRICK MCAULIFFE ' oy w�- O�prQjy� NEW YORK STATE LICENSE NUMBER 050871 Scale 1 = 30 - Surveyed November 3, 2018 FIDELITY NATIONAL 9& CE COMPANY�/� 87 woody ew Lane ----GRAPHIC--SCALE - � - - - --. -- - - - -- -- -- -- ----- � - - ---Centereach;---N_Y.- 11-720 - -- - - - _ PHONE/FAX: (631) 580-1202 30 0 15 30 so X20 - - - ---- TAT CELLULAR: (631) 766-9714 1� EMAIL: mikemintolspc®gmail.com ( IN FEET ) 1 inch = 30 ft. Glenn Golds'_ 'i, President ���S�FFO(�� Town Hall Annex A. Nicholab-�rupski, Vice-President �� yam, 54375 Route 25 John M. Bredemeyer, III N 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 Date/Time: 60�7�21 Completed in field by: ,N'14&P-4e 2500 GRATHWOHL RD LLC requests a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed and to remove poison ivy. Located: 2455 Grathwohl Road, New Suffolk. SCTM#: 1000-117-1-3 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 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: Ak Godtejt . A 6 I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J. Bredemeyer M. Domino G. Goldsmith ✓ N. Krupski G. Williams Other THE EXISTENCE OF RIGHTS OF WAY UNAUTHORIZED ALTERATION OR ADDITION WX NAI CHECKED MM DATE TOIL 2018 DRAWING 'OB NO. 18-1180 AND/OR EASEMENTS OF RECORD IF TO THIS SURVEY IS A VIOLATION OF ANY, NOT SHOWN ARE NOT SECTION 7209 OF THE NEW YORK STATE GUARANTEED. EDUCATION LAW. iCOPIES OF THIS SURVEY MAP NOT BEARING S73a21' L OR OQE EMBOSSED THE SEAL HALL D SURVEYOR'S INKED BE" CONSIDERED 22 QQ, TTO BE A VAUD TRUE COPY. rONLY TO THE PERSON FOR WHOM Rpaa GUARANTEES INDICATED HEREON SHALL RUN n S PREPARED, AND ON HIS BEHALF TO RVEY O THE ,r `a+� TITLE COMPANY, GOVERNMENTAL AGENCY AND 1 Pho/� LENDING INSTITUTION LISTED HEREON, AND Gt m 5.73.21001, �� TO THE ASSIGNEES OF THE LENDING INSTI— Q� r r mm' moo, ^ E TUTION. GUARANTEES ARE•NOT TRANSFERABLE �)� & wot ��o��e ° 19 F E Q met �°`�"'�f�� Tax Lot 10 known as: oQ os of J\�i ^ o W r COt AreQ to 160 # 2500 Grathwohl Rood, New Suffolk T a ; , p lylS � V � or r Z Z5 AIS 3 - w ;- W.'` �� LgNO Q r� 49.1'• 112 Qo,, r *�• .;o w, : - ¢ ..., y = SEP 2 4 .202\1 • , • ' � '•°�_ a � ;o, , ` •��.- _•�, per{ � , .. ,_ - - • ., . - S,00101d•Town B 1.. x- !�d °` �; , oard of Trustees 0o :r ;'.S .=, •'�:�� .. -r,,; :., .,�.. Jr -rem 153 ArIce vz e" 80',201- p : Survey of Described*,Properties N _ Fp 5 situate' a# r T' 4OT , 3.2��- "w � m New Suffolk POte Town , of Southold Suffolk County, New York- District 1000 Section 117 Block 1 Lot 3 & Certified to: Michael W. Minto, L.S.P. C. JENNIFER FOLEY LICENSED PROFESSIONAL LAND SURVEYOR District 1 .000 Section 117 Block 2 Lot 10 PATRICKMCAULIFFE NEW YORK STATE LICENSE NUMBER 050871 Scale 1 "= 30' Surveyed November 3, 2018 , FIDELITY NATIONAL TITLE INSURANCE COMPANY 87 Woodview "Lane GRAPHIC SCALE t Cen terea ch, N. Y. 1-1720- . � PHONE/FAX: (631) 580-120230 o is so so 120 �7 CELLULAR: (631) 766-9714 ►� EMAIL: mikemintolspc®gmail.com ( IN FEET ) , --- - - 1 inch- = 30 .-f - - -- -- - - - - - -- --- - -— - - - - - THE EXISTENCE OF RIGHTS OF WAY UNAUTHORIZED ALTERATION OR ADDITION DRAWN MM CHECKED MM DATE NK 2018 DRAWING & JOB N0. 18-1180 AND/OR EASEMENTS OF RECORD IF TO THIS SURVEY IS A VIOLATION OF ANY, NOT SHOWN ARE NOT SECTION 7209 OF THE NEW YORK STATE GUARANTEED. EDUCATION LAW. COPIES OF THIS SURVEY MAP NOT BEARING S73-2'' L OR op"E T l EMB SSD SEAL SHALL THE LAND SURVEYOR'S INOT DBEECONSIDERED 22,o p, / Ujh',, ®� TO BE A VALID TRUE COPY. ` � GUARANTEES INDICATED HEREON SHALL RUN ' ONLY TO THE PERSON FOR WHOM THE SURVEY PO,e IS PREPARED, AND ON HIS BEHALF TO THE 91/ys TITLE COMPANY, GOVERNMENTAL AGENCY AND ° S73°21 ,� sPholt'�°yement TONTHE ASSIGINEESDING OFTUTION THED HEREON,E LENDING INSTI— �� pO E` TUTION. GUARANTEES ARE NOT TRANSFERABLE. LO / r c o oQQ(o�\����, ��g Q Q T toter meter dement edge Tax Lot 10 known as: oil r.9�05 0 : 00 p $ W Are. AX COT 10 z , o 0 1$39 ^ 6p.68, 2500 Grathwohl Road, New Suffolk es 1 ''� o n 8 s.f 2 04' / 3 ' 00 co E W &ND�4,q TAA' C0T 3 /�r Z ^ 129' PF �Q �� 49.1' c r ,O o O 68' o a �o 12.op° "� Q ,4 , y 3 SEP 2 4 2029 ® a` bosemeo N N entrOnce t , y N73720® = F N ."'� Souti�dd ,bvfn 1 p , °Ond co Board of i�rustets TqX COT 4 0 �{/ MOnOment 32 4• 59 e °vefio a Wolk �I� t3 9rov ,o n9s orbor Oyer Potio o 01 jv® V 1.35 et drnewo' loading o �W. ®�1 a t�„e ce C G9 1,53.72' c 323, 201,Ooroge 80' o Survey of Described Properties 12Z , , situate at T COT , 1V73*21>0p"W , W ��- 1 a, ® ofi/,ty c New Suffolk P°ie Town of Southold Suffolk County, New York District 1000 Section 117 Block 1 Lot 3 & Certified to: Michael W. Minto, L.,S'.P. C. District 1000 Section 117 Block 2 Lot 10 JENNIFER FOLEY LICENSED PROFESSIONAL LAND SURVEYOR PATRICK MCAULIFFE NEW YORK STATE LICENSE NUMBER 050871 Scale 1 "= 30' Surveyed November 3, 2018 FIDELITY NATIONAL TITLE INSURANCE COMPANY 87 Woodview Lane GRAPHIC SCALE Cen tereach, N. Y. 11720 PHONE/FAX: (631) 580-1202 so o is 1 so X20 CELLULAR: (631) 766-9714 EMAIL: mikemintolspc®gmail.com ( IN FEET ) 1 inch = 30 ft. o N VI 47- -OB O i�. Reisom 1.N 1481 x oFm�>AO W12al W x01 9 N IDa,N � 1 U. fib) LINE 9615m �k4'.'�% I -.._-..ti � w �•� ' ] SEE SEC.NO. +38c Ito e03a "2 m m41J O Lt.Ncl t9.yc1 TUTHILL RD. f w Ll y/c,o y 1 .a x0.1 203 9'� a1 1 f�aq 1t w p O ns A .>w t S Ix - ,B w2 m y3f(CI O 12 FM ML N0. 13+ LtNcl t tNcl q a f{I SEg SEC.NO. '>n k 5 1dA 4 t / OSoO+ 14 ° 13' to x 1)3 A 11A1c1 e T `la � +oeP x a' ,ep u9 as x5 6+wa s1.1 ( is w x3A m3 x J �e 121 s t3 a 9I� CUTCHOGUE +x m e tANU I .., +s m ®� HAR80R 19+" w ) u sl g :xMU •._,\ LeNU ..4 IT fW1ER Rwxwli1 I.. 3 19A1U 1+ �'38- i]p 6xy iNii It A w1�'. t�cl � y tvn B � pIiLRAPO m ST. w 8 m `; ].WU it 13..i 21, w • a w p s a s -'al 1, m w N W _34,- ' 131 12 11.1 111 "^ � s RD. m i �z3 a iB a ] y1e y3 9 .!.`» yIWU f tfi.p the i w � aplp e. fi Yt iµ I z3 a r i +13 IBA 1.IA 9 ibw"N 2p.362a.J MNN p3 20128 JB_ � .YpM+a 11 13 • typ+ w +63 m 0 JaLR30N 1 t x wp•3 N tpt IB3� .m O,.W t€ -�_ 1 11.8(4 1.41 13 i +2A -, tat 15 10.9 ago. a39tM10 N \-/ ' z.1.yq teiNq n �- w f.z i 29 w w �._..._ wt3 SAT 1 COUNTY OF SUFFOLK © E m SOUTHOLD SECTION NO I s.� ------ .+ YReal Property Tax Service Agency V 117 C9 OceM M9 .-NN H 1 11] s P rmcr uo 10011 PROPERTY IMP '��'��� "<•',"��u.». a y;�,�w OFFICE LOCATION: A� "� 4 MAILING ADDRESS: n Town Hall Annexe p` P.O.Box 1179 54375 State Route 25 �'�� Southold,NY 11971 (cor.Main Rd. &Youngs Ave.) Southold, NY 11971 � Telephone: 631 765-1938 LOCAL WATERFRONT REVITALIZATION PROGRAM TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: October 12, 2021 Re: LWRP Coastal Consistency Review of 2500 GRATHWOHL RD LLC SCTM# 1000-117-1-3 2500 GRATHWOHL RD LLC requests a Ten (10) Year Maintenance Permit to hand-cut Common Reed (Phragmites australis) to 12" in height by hand, as needed and to remove poison ivy. Located: 2455 Grathwohl Road, New Suffolk. SCTM#: 1000-117-1-3 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. 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 J ARTICLES OF ORGANIZATION OF 2500 Grathwohl Rd LLC Under Section 203 of the Limited Liability Company Law FIRST: The name of the limited liability company is: 2500 Grathwohl Rd LLC SECOND: The county within this state, in which the office of the limited liability company is to be located is Suffolk. THIRD: The Secretary of State is designated as agent of the limited liability company upon whom process against it may be served. The address within or without the state to which the Secretary of State shall mail a copy of any process against the limited liability company served upon him or her is: THE LIMITED LIABILITY COMPANY 2500 Grathwohl Rd New Suffolk,NY 11956 I certify that I have read the above statements, I am authorized to sign these Articles of Organization, that the above statements are true and correct to the best of my knowledge and belief and that my signature typed below constitutes my signature. Limary Hewes, Organizer(signature) Limary Hewes, ORGANIZER 25 ROBERT PITT DR. SUITE 204 MONSEY,NY 10952 Filed by: Vcorp Services,LLC 25 Robert Pitt Drive, Suite 204 Monsey,New York 10952 VCORP SERVICES, LLC (HD) DRAWDOWN CUSTOMER REF# 3038597 Glenn Goldsmith,President �S,A Town Hall Annex 54375 Route 25 A.Nicholas Krupski,Vice President , P.O.Box 1179 John M.Bredemeyer III i.` Southold,New York 11971 Michael J.Domino . Telephone(631) 765-1892 Greg Williams "%�: �'�' _ Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD - - _ This Section For__Office C E U V E Coastal Erosion Permit Application ® �1 Wetland Permit Application K Administrative Permit SEP 2 4 2021 AmendmendTransfer/Bxtens n I( Received Application: Received Fee: $ ��•®0 �. . tjompleted Application:, •2 .Zig Y-T°'" Incomplete:.. SEQRA Classification: TypeI Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date:, Coordination:(date sent): __74LWRP Consistency Assessment Form Sent: - CAC Referral'Sent:- _ Date of Inspection:. Receipt of CAC Report:. - - _,jechnical Review: Public Hearing Held:_ Resolution:,- _- Owner(s) Legal Name of Property(as shown on Deed): �AmL1d�AAg(,1W 4Wt3 t?f_Q_ Mailing Address: �z'w .Su[fqt1C KV Phone Number:, 4 — �'l t7- L 144 �.CA -t--� . Suffolk County Tax Map Number: 1000 - Property Location:,-2j &j_A•CI LZG Kk_ Q�p (If necessary,provide LILCO Pole#, distance to cross streets,and location) AGENT(If applicable): Mailing Address: Phone Number: Email: J ` m C ck o�I e NlA 0 C^ Board of Trustees Apple tion GENERAL DATA Land Area(in square feet):_ ► Area Zoning:, - P,'Lt0- - - - - - - - - Previous use of property: Intended use of property: �3 0`FtANVs 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 , 4,No If"Yes", be advised this application will be reviewed by the Building Dept. prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes, . -No If"Yes",please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? _Yes No J Does the structure (s) on property have a valid Certificate of Occupancy? Y 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): OT_. _ 19R/WG_Ir(;s Ma 5 0ts - (U'y _ _0A)1_­ S t S A- to —`IgAiL P6A_u1c�_ Board of Trustees Apply tion WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations:.. Tp__-o_ _ _Go k-%(Lo�-_ TK& 6,o cao^c H wA 121 t Area of wetlands on lot:__ ;��2.GU square feet Percent coverage of lot:,- Closest ot:,-Closest distance between nearest existing structure and upland edge of wetlands: feet Closest distance between nearest proposed structure and upland edge of wetlands: N feet Does the project involve excavation or filling? . ,--- X No - Yes 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:_. feet Proposed slope throughout the area of operations: .. Manner in which material will be removed or deposited::_ t 1� W It,L ( (Z&o v6&6 AMID P204740-01 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): 61 Z20 Appendix B Short Environmental Assessment Form Xi1StCUGflflri_S;�'f+Dr�oiriiilefing Part I -Project Information. The applicant or project sponsor is rQsponsible 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 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 P{'�R-lGli• VNC._ +�V 1.1�� _��!7 t�F>�tL '�,L.i✓'1 - - - - - ------------ --- --= -- - - --- ---- ---- - --- - - -Name of Action or Project: puP...��un��s Po 1s�4� �,vK__- -C�TTI I�C� _ Ttt1r�►w�+d.� . , Project Location(describe,and attach a-location map-):-- Brief ap):Brief Description of Proposed Action:; Ma%ZCT to SIL'- NA- 1MIA1 WTb0AaC G P6&*%\l Ccs T ?K&Giwnl'\SS APP ev%&c+3 \Vy, ox--, go Name of Applicant or Sponsor: _ - - - "-Telephone: •-t' �O P 4k4,-r E-Mail:• � - - - • moo 'Address: o. Q)o0, 2.L3 - - City/PO: — - — — ---- --= — ;Stater:__ __ - Zip Code: New -!>0FzL0k_W K 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 i If Yes,list agency(s)name and permit or approval: pa �1✓G - Li.-Total--acreageof the site of the proposed action? acres b.Total acreage to be physically disturbed? ! 02 _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. 7 i , ❑Urban ❑Rural(non-agriculture) [:]Industrial ❑Commercial Residential(suburban) El Forest ❑Agriculture El Aquatic ❑Other(specify): E: ❑Parkland Page 1 of 4 -5.- Isthepwopbse-d-action-, N-0 YES N/A a.A permitted use under the zoning regulations? I EIT rl IVI , 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 i landscape? Ell 7. Is the site of theproposedaction located in,or does-it adjoin,a state listed Critical Environmenfil Area? NO 'YES If Yes,identify: 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? F71 0 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: Mv ,,I X-J 10. Will the proposed action connect to an existing public/private water supply? NO1--YES If No,describe method for providing potable water: El proposed action connect w__ !1 N6 YES 11.Wilftfie�-p 'to-existing wastewater-utilities? If No,describe method for"providing wastewitertreatment:.--- M7 12. a.1366sthe site contain a-structure that is listed on either-the StateorNational--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.Mould 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: ___ _ _ °-,o, 14. Identify the typical habitat types that occur on,or are likely to be found on the project site. Check all that apply;,- [AShoreline ElForest El Agricultural/grasslands El Early mid-successional Wetland 0 Urban ❑Suburban 15.Does the site-of the proposed action contain any species I ofa animal,or associate-d-habitats,listed NO, YES, by the State or Federal government as threatened or endangered? 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? ONO OYES M C-1 - b.Will,stbOwater discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,brigfly,describe: 0 NO OYES Page 2 of 4 18.Does the proposed action include construction or other activities that result in't66 impoundment of- NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? I If Yes,explain purpose and size:, IV— 19.Has the site of the proposed action or an adjoining property been the location of an active or closed NQ _,-'YES solid waste management facility? If Yes,describd-.", V3, E] 20.Has the site of thepiopo-sed action oran adjoining property been the subject of remediation(ongoing or `t NO__. YES completed)for hazardous waste? If Yes,describe: ---- - - F91 Ell I AFFIRM THAT THE INFORMATION PROVIDED ABOVE IS TRUE AND ACCURATE TO THE--BEST OF MY KNOWLEDGE :Applicant/sponsor Date: Signature: Tart 2-Im pact 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 1. Will the proposed action create a material conflict with an adopted land use plan or zoning regulations? L-JI 2. Will the proposed action result in a change in the use or intensity of use of land? 3. Will the proposedaction impair the'character or quality of the existing community? 'El 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? 7. Will the proposed action impAct existing: ❑ 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, _Architectural or aesthetic resources? 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? Page 3 of 4 No,or Moderate . small to large impact impact r may may i occur ! occur 3 10. Will the proposed action result in an increase in the potential for erosion,flooding or drainage I -{-=-- pioblems? j 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. ', ' 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 i Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer f Signature of Responsible Of icer in Lead Agency Signature of Preparer(if different from Responsible Officer) , PRINT Page 4 of 4 Board of Trustees Appli7)tion :AFFIDAVIT �mUcy uc `Q- 'JVlm BEING DULY SWORN DEPOSES AND AFFIRMS THAT VSHE 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 er Signature of Property Owner �6PT ,.20 6X_ �l SWORN TO BEFORE ME THIS_. __. -_:..._DAY OF_ _. __ _ __ _ ___O­ Pu 11C - - _- JONAT9AN LEWS YORK tdOTARY PUBLIC-S TATE OF NEIN No.p1LE6136116 Qualified in Nassau County Nty Commission Expires 10-31-2021 Board of Trustees Appl= �',tion =AFFIDAVIT, '_S:&'NTg2- P-tit ( BEING DULY SWORN DEPOSES AND AFFIRMS THAT HE/SHE IS THE APPLICANT FOR THE ABOVE DESCRIBED PERMITS) AND THAT ALL STATEMENTS CONTAINED HEREIN ARE TRUE TO THE BEST OF HIS/HER KNOWLEDGE AND BELIEF,AND THAT ALL WORK WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SOUTHOLD TOWN BOARD OF TRUSTEES. THE APPLICANT AGREES TO HOLD THE TOWN OF SOUTHOLD AND THE BOARD OF TRUSTEES HARMLESS AND FREE FROM ANY AND ALL DAMAGES AND CLAIMS ARISING UNDER OR BY VIRTUE OF SAID PERMIT(S),IF GRANTED. IN COMPLETING THIS APPLICATION,I HEREBY AUTHORIZE THE TRUSTEES,THEIR AGENT(S) OR REPRESENTATIVES,INCLUDING THE CONSERVATION ADVISORY COUNCIL,TO ENTER ONTO MY PROPERTY TO INSPECT THE PREMISES IN CONJUNCTION WITH THIS APPLICATION, INCLUDING A FINAL INSPECTION. I FURTHER AUTHORIZE THE BOARD OF TRUSTEES TO ENTER ONTO MY PROPERTY AND AS REQUIRED TO INSURE COMPLIANCE WITH ANY CONDITION OF ANY WETLAND OR COASTAL EROSION PERMIT ISSUED BY THE BOARD OF TRUSTEES DURING THE TERM OF THE PERMIT. Signature of Property Owner. _ r ~Signa re of Property Owner SWORN TO BEFORE ME THIS --- --:DAY OF__�G� 4•( �-_ _ ,;20__Zd ' Not -- "lie JpNp,THPAN i-Of sevq YORK Y PURI IC S�AjE 6118 NpTA� No 01`Na sauCountY lified in Qua m�ssion ExPkves 10-31 2621 MV CO s ay x 3 APPLICANUAGENUREPRESENTATI E TRANSACTIONAL DISCLOSURE FORM f It rT(ie`Town of Sr�u�hold's rule t f Ethics lilts conflicts pf ntereston tfie f®f towirot c'e-rslia-employeos'`'flieAir'ridse'di' this form`is to,nrovide nfo''rination iwhich osiralert t#te ttiwn'of oossiblc cbnflidts.of ihterest a[ul allow it tb#a1Ge rh{iteyer aafion`is; necessarV-'4o•&.�d_rsari_ie: r .1A. YOUR NAME: P"((L��>~ Y ATtAyY4 (Last name,first name,giiddle 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.) �7j a NAME OF APPLICATION: (Check all that apply.) Tax grievanceBuilding 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,marriage,or business interest."Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or employment by)a corporation in which the town officer or employee owns more than 5%ofthe 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/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day,o01A �&4*t20A Signature -, _ Print Name ?LUCK_WULI FIS_ Form TS I j01Pj A,N EWISBV YpaK .f pU6�1C-S-V 18 NOTA k Q�LE61 No• a C 3� 20�1 Dualltied in gas 10- Mv EXpkres Comm`ss►6n APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE FORM :Tlte`'Tti�yirof Sautliold's Code of Etfiicrnliibir$conflicts ojnterest on She>par't of town iiffioers aiid employees`Tlie'puroiise'pf tliis form is fwprrovide'inforirisition zi+liicltican lert'tlie town uF ssibletconflicts of tcr`"est acid-aoVic tri'takeIwhatevee aatioii;is; 3ridcessarX;16"d`sarrie: ` - - ---- - - YOUR NAME:: .. 'Fo L G-( 11 61JN t na, (Last name,ft t name,middle initial,-u�ess you are applying:in;the name of someone else or other entity,such as a company.If so,indicak 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,marriage,or business interest"Business interest"means a business, including a partnership,in which the town officer or employee has even a partial ownership of(or'employment by)a corporation in which the town officer or employee owns more than 5%of the shares. YES NO If you answered"YES",complete the balance of this form and date and sign where indicated. Name of person employed by the Town of Southold Title or position of that person Describe the relationship between yourself(the applicant/agent/representative)and the town officer or employee.Either check the appropriate line A)through D)and/or describe in the space provided. The town officer or employee or his or her spouse,sibling,parent,or child is(check all that apply): A)the owner of greater than 5%of the shares of the corporate stock of the applicant (when the applicant is a corporation); B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this ay of 20k2-1 Print Name Form TS 1 WAS JONATHAN Of �tEW Y TE NpTARY P No ,-S6A36UCoun Z OualrEied in Nassres 10-3 " My comm155 1on ExP Town of Southold U 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 coastaharea(which includes all of Southold Towner _ _-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-su_ pporting and non- supporr;`facts: If an action cannot-be certified as consistent with the LWRP policy standards and' conditions,rt shall nolibe,,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 PROJECT NAME AM-Cr---lAt e =-6UuF-W The Application has been submitted to(check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑ Board of Trustees j 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) :a: (b) Financial assistance(e.g.grant,loan, subsidy) (c) Permit,approval,license,certification: Nature and extent of action: AANUAQ j Cu i eHMAuaIT&S _ ANS'- - - �o1S� Location of action: .2S�b b �7L "C,_ (ZaAA 1 ll)G A3 Sy F FoL k Site„aaeage:_ Present land use: _V NCGLti? _ _ W AURL�'t�p ry t _ Present zoning classification:___9'_&S%DS-0-Mat-- L 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: f'WTO-t 1� 1 �_ AVLtffeSVOr.3 FOUL-m GL.&K (b) Mailing address: p-0Ao-/- 2.4:1, , POO Sof&k-W (c) Telephone number: Area Code O 4 4-1 (d) Application number,if any:, Will the action be directly undertaken,require funding,or approval by a state or federal agency? Yes 0 No�: If yes,which state or federal agency? - _ = C. Evaluate the project to the following policies by analyzing how the project will further support or not support the policies. Provide all proposed Best Management Practices that will further each policy. Incomplete answers will require that the form be returned for completion. DEVELOPED-COAST-POLICY Policy 1. Foster a pattern of development in the Town of Southold that enhances community character, preserves open space, makes efficient use of infrastructure,makes beneficial use of a coastal location, and minimizes adverse effects of development. See LWRP Section III-Policies; Page 2 for evaluation criteria. F]Yes R. No Not Applicable Attach additional sheets if necessary Policy 2. Protect and preserve historic and archaeological resources of the Town of Southold. See LWRP Section III-Policies Pages 3 through 6 for evaluation criteria E: Yes}_ 'No © Not Applicable Ir~� 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 10 Lk- N-enoua G�WKgWcc� It, sC&M1c`. ISGA M _ CtlGt?K f2o = t=_aro, 0y ►oNl.odv�- [3 �iS 4-_==CSZ:ni,�i0�ip t� ti Cid . '1�� Pt-��G�w+►��s Attach additional sheets if necessary -- — — -—- - ----- NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria Yes ❑ No 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. Yes No r' 'Applicable I i S&L 12 Sj 1T14 l P 7116 Ipm 2446r r A tTt5�9 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 -0 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 LWRP Section III=Policies; Pages 34 through 38 for evaluation criteria. ,,0 Yes 0 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. 'i'ei:l No FZ Not Applicable Attach additional sheets if necessary - _ - WORKING COAST PC_CIES Policy 10. Protect Sbuthold'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. >,QaYes No ® Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. 11:1 Yes [I No'191 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. F Yes No® Not Applicable Attach additional sheets if necessary Policy 13. Promote appropriate use and development'of energy and mineral resources. See LWRP Section III—Policies; Pages 65 through 68 for evaluation criteria. Yes No ® Not Applicable PREPARED BY_.. -- _---- TITLE_, R-_ .,, .._.,DATE zcZ