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Home My WebLink AboutTR-10023A Glenn Goldsmith, President �QF SQ(/Ty Town Hall Annex A.Nicholas Krupski,Vice President �� 54375 Route 25 P.O. Box 1179 John M. Bredemeyer III l [ [ Southold,New York 11971 Michael J.Domino G Telephone(631) 765-1892 Greg Williams Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD SOUTHOLD TOWN BOARD OF TRUSTEES YOU ARE REQUIRED TO CONTACT THE OFFICE OF THE BOARD OF TRUSTEES 72'HOURS PRIOR TO COMMENCEMENT OF THE ACTIVITIES CHECKED OFF BELOW INSPECTION SCHEDULE Pre"-construction, hay`bale line/silt b6oMh5ilt:curtain _ , 1St-0ay-of,c6nstruetion , ==: 'h,constructed- When,prohct,cornplete,"call-fer,cornplianee inspection;- Glenn Goldsmith,PresidentorjF SOUrl 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 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Permit No.: 10023A Date of Receipt of Application: October 29, 2021 Applicant: Olson Family 2020 Trust SCTM#: 1000-73-1-2.2 Project Location: 14995 Oregon Road, Cutchogue Date of Resolution/Issuance: November 17, 2021 Date of Expiration: November 17, 2023 Reviewed by: A. Nicholas Krupski, Vice-President Project Description: Clear an approximate 4'x465' path to the top of the bluff. Findings: The project meets all the requirements for issuance of an Administrative PermiYset forth in Chapter 275 of the Southold Town Code. The issuance of an Administrative Permit allows"for the operations as indicated on the site'plan prepared by Robert I. Brown Architect, P.C., dated October 14;',2021, and stamped'approved on November 17, 2021. Special Conditions: No trees are to be removed in order to'make the path. 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 ISSUES/REVISIONS L OA G I LONG 1 s.�ND S N O so UNC N e ¢ I o j Mw BLKW-ADIMW AM ,�8.68SY ""9, a 07�¢9 I Tm DE�� 30 MHW ALONG BULKHEAD STONE ARMOR x p EXISTING o STONE BW 5O WOOD Imo ARMOR BULKHEAD -- ' SEEPAVI'MANEOR TOE OF BLUFF I �^�� PROVIDE;WIDECTPARED PROEM IUC S REF PROERTT NTH6ARFA PROVIDE]WIDE CIFA ED PATH THRU CENDiR PROEM IN THIS "�aF 1 1®Qt �0.I O Of N/r OF WD n��. !Ell. ;P ra SEARMA MAW racer to m DwEUJW DWELUNO w/*aL wATM N 51 0• wwAIR 13. __.- _-- ►P �a+�03, W;! an PN N 51'23'30" E «� '�""e�Al'ru' ASTLE HILL ROK rQ o o O - 72 O O _ 70 V , 72 N to C+1 ti 70 _ GA Cz ` THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF THE ARCHITECT.INFRINGEMENTS WILL R�Sr OF B BE PROSECUTED L UFF 2o21 ALL RIGHTS RESERVED 66 f6 �O/1(� to D N/F OF 72 /��J Tq4 EROS mm -� - Robert I. Brown xo v ygZq CA Architect, P.C. 74 RO e0(/NO zo55 Bay Ave. Greenport NY qRY inro@ribrownarchitect.com - 631-477-9752 IT IS A VIOLATION OF THE LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED ARCHITECT,TO ALTER ANY ITEM ON THIS DRAWING IN ANYWAY.ANY AUTHORIZED ALTERATION MUST BE NOTED,SEALED,AND DESCRIBED IN ACCORDANCE WITH THE LAW. i PROVIDE 4 WIDE CLEARED PATH THRU CENTER OF PROPERTY IN THIS AREA c2 ELEV.61.7 nt ORCY NOL %WDY LOW ��- `NE SM LOAMY SAND Z G2PRORW - �'F M - o CLIENT/OWNER F �iNF PART SITE PLAN SPS APPROVED BY 8''' BOARD OF t�USTEES OLSON FAMILY SCALE: 6..=1 - ZONE'AC' r2 ME" C2 TOWN OF SOUTHOLD 202o TRUST Sw SAND mva DATE NoVpM.Wg 17, Z07-1 NO WATER fA JULY 24, 2021 17• roN c2' f2 243.85' J� K wOYCHUK LS '1 +i?✓!1iL S 51.41'20"_..1I 490.91' . 11ON• MW OF PAVMWW OREGON ROAD PROJECT TITLE 62 SITE PLAN`` — BASED ON SURVEY BY NEW RESIDENCE �»mT : NAwes KEN WOYCHUK Oregon Road >�:AC 581,600 SF = 13.35A Cutch g DATED MARCH 29, 2021 Cutchogue,NY 11935 S.C.T.M.# 1000-73-1-2.2 - ... ... T....._ .. _.1 DRAWING TITLE < i I } SITE PLAN _ GENERAL NOTES Southold Town Flo -d of_T ruster's _ - SCALE Oct.14,2021 NOTED DRAWING NO. ken woychuk 58i,600 sf=i3.35A mar 29, 2021 Glenn Go:" With, President ��0 p� Town Hall Annex A. Nich:vgas Krupski, Vice-President 0 - tom, 54375 Route 25 John M. Bredemeyer, III o ` P.O. Box 1179 Michael J. Domino oSouthold, NY 11971 Greg Williams yelp® �� Telep on 765-6641-1892 Fax BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD Date/Time: I I It LZ( Completed in field by: NV Robert I. Brown, Architect, P.C. on behalf of OLSON FAMILY 2020 TRUST requests an Administrative Permit to clear an approximate 4'x465' path to the top of the bluff. Located: 14995 Oregon Road, Cutchogue. SCTM#: 1000-73-1-2.2 CH. 275-3 - SETBACKS WETLAND BOUNDARY: Actual Footage or OK=� Setback Waiver Required, 1. Residence: 100 feet 2. Driveway: 50 feet 3. Sanitary Leaching Pool (cesspool): 100 feet 4. Septic Tank: 75 feet 5. Swimming Pool and related structures: 50 feet 6. Landscaping or gardening: 50 feet 7. Placement of C&D material: 100 feet TOP OF BLUFF: 1. Residence: 100 feet 2. Driveway: 100 feet 3. Sanitary leaching pool (cesspool) 100 feet: 4. Swimming pool and related structures: 100 feet Public Notice of Hearing Card Posted: Y / N Ch. 275 Ch. 111 SEQRA Type: 1 II Unlisted Action Type of Application: Pre-Submission Administrative Amendment Wetland Coastal Erosion Emergency Violation Non-Jurisdiction Surveys 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: —OK -fa Cher U q' V,%-4 -to 6111- a�j 4k co'j,44-0-.1 f Afo 46ev cAre' oj fL) Z R;M/4!::�4 I have read & acknowledged the foregoing Trustees comments: Agent/Owner: / Present were: J. Bredemeyer M. Domino G. Goldsmith ✓ N. Krupski G. Williams Other ISSUES/REVISIONS LONG I "Oft IS Sj"4ND SPUN z D N 6 4g so. MNW A< AD/sroNE ARMOR 0. OF wooD N ,-'8.68-9 X704 MHW ALONG BULKHEAD/STONE ARMOR ARz ' °�BLUFF 9 3kx FF 41 n to � Q 1� EXISTING 1 �� STONE �29, gW 5•0 WOOD ��ARMOR BULKHEADS` - - ' SEE PART PLAN FOR TOE OF BLUFF ' TIRS ARFA PROVTDE4 WIDE C PATH TFIRU ROF CENTER OF -- _ -- __ -- ' PROEM IN THIS ARIA PROVIDE]WIDE D PATH THRU CENTER PROERTY IN THIS AR M/F OF It�)t LP. - i o P LAW MIF OF IAM If OF INRI'Yg41Y m lcCEAIiE ARCMDWELU , W/WaL WAT N 51 0" DWULM ER w w+TETt O I 13. 8„�0•� noM nn 31•�ig'g3 N 51'23'30” E ,,u ~A01DWAy CASTLE HILI. ROAD�� - -1 O o O O _ Clt VY .tom 70 10 V O O -72 J IR C- H 70 Cz 10 c� 68 _ THESE PLANS ARE AN INSTRUMENT OF SERVICE AND ARE THE PROPERTY OF THE ARCHITECT.INFRINGEMENTS WILL RBST BE PROSECUTED of 2o21 ALL RIGHTS RESERVED ES LAW CogsT -M - � Robert I. Brown �2 q� �RosioN Architect, P.C. RD 205 �, 20 Bay Ave. Greenport NY 7� (IN�gR info@ribrownarchitect.com Y 631-477-9752 IT IS A VIOLATION OF THE LAW FOR ANY PERSON, UNLESS ACTING UNDER THE DIRECTION OF A LICENSED ARCHITECT,TO ALTER ANY ITEM ON THIS DRAWING IN ANY WAY.ANY AUTHORIZED `- - ALTERATION MUST BE NOTED,SEALED,AND DESCRIBED IN ACCORDANCE WITH THE LAW. 62 A PROVIDE 4'WIDE CLEARED PATH THRU CENTER OF PROPERTY IN THIS AREA E1F1!61.7 CQ \ OL DriOAM NE" SM LOAMY SAND x .... W EIRM TRFu - c CLIENT/OWNER MEDImUM N PART SITE PLAN SP SAND 87, GRAVEL � OLSON FAMILY -- - SCALE- CA 6., ZONE'AC' PALE E2 202o TRUST MEDIUM Sw SAND h A _--- GRAVEL NO WATER CA —t JJULY24,, Ls S 51.4120C21 MW62,- -C2 z 243.85' to '20"_.1I_ 490.91' 110"L \\ d., PROJECT TITLE OREGON ROAD 62 SITE PLAN Aff 150'— BASED ON SURVEY BY NEW RESIDENCE S(AU:"'d KEN WOYCHUK 144995 Oregon Road TUAf-- AXWATTONLNNAVD88ZOM-AC 581,600 SF = 13.35A DATED MARCH 29, 2021 Cutc ogue,NY u935 S.C.T.M.# 1000-73-1-2.2 U T_1 lS DRAWING TITLE 1.: or 2 9 2,�E SITE PLAN GENERAL NOTES Southold Town Boardof Trustees ---.....,__. .__ SCALE OCL 14,2021 NOTED DRAWING NO. --- ken woychuk 581,600 sf= 13.35A mar 29, 2021 SDUW do ax ----------- COUNTY OF SUFFOLK PeftT.S.�Agwy RI.11 OFFICE LOCATION: MAILING ADDRESS: Town Hall Annex � M' P.O.Box 1179 54375 State Route 25 �� " Southold, NY 11971 (cor. Main Rd. &Youngs Ave.) '" Southold, NY � �� Telephone: 631 765-1938 www.southoldtownny.gov PLANNING BOARD OFFICE TOWN OF SOUTHOLD MEMORANDUM To: Glenn Goldsmith, President Town of Southold Board of Trustees From: Mark Terry, AICP LWRP Coordinator Date: November 16, 2021 Re: LWRP Coastal Consistency Review for OLSON FAMILY 2020 TRUST SCTM# 1000-73-1-2.2 Robert I. Brown, Architect, P.C. on behalf of OLSON FAMILY 2020 TRUST requests an Administrative Permit to clear an approximate 4'x465' path to the top of the bluff. Located: 14995 Oregon Road, Cutchogue. SCTM#: 1000-73-1-2.2 The proposed action has been reviewed to Chapter 268, Waterfront Consistency Review of the Town of Southold Town Code and the Local Waterfront Revitalization Program (LWRP) Policy Standards. Based upon the information provided on the LWRP Consistency Assessment Form submitted to this department, as well as the records available to me, it is my recommendation that the proposed action is CONSISTENT with the LWRP and therefore CONSISTENT with the LWRP. 1. It is recommended that trees are avoided to further Policy 6. Pursuant to Chapter 268, the Board of Trustees shall consider this recommendation in preparing its written determination regarding the consistency of the proposed action. Cc: Damon Hagan, Assistant Town Attorney Glenn Goldsmith,President f�� q� SO Town.Hall Annex ` �� A. Nicholas Krupski,Vice President �� ! 54375 Route 25 Y P.O.Box 1179 John M.Bredemeyer III Southold,.New York 11971 Michael J.Domino Telephone(631) 765-1892 Greg Williams & Fax(631) 765-6641 BOARD OF TOWN TRUSTEES TOWN OF SOUTHOLD This Section For Office Use Only Coastal Erosion Permit Application Wetland Permit Application X Administrative Permit Amendment/Transfer/Extension Received Application: l0•�•� Received Fee: $ 100.00 _Completed Application: �' •Zl Incomplete: SEORA Classification: Type I Type II Unlisted Negative Dec. Positive Dec. Lead Agency Determination Date: oordination:(date sent): _ ��_.- ._rty .N LWRP Consistency Assessment Form Sent: f nr i CAC Referral Sent: I� I r Lq IE Date of Inspection: l I• Receipt of CAC Report: OCT 2 9 2021 Technical Review: Public Hearing Held: 11 17-AA— Resolution: Southold Town Board of Trustees Owner(s)Legal Name of Property (as shown on Deed): !� X2 Mailing Address: 4YAL�� g Phone Number: Suffolk County Tax Map Number: 1000 - 7 " I -: - Property Location: (9 (If necessary,provide LILCO Pole#, distance to cross streets, and location) AGENT(If applicable): (. Mailing Address: ' r Phone Number: Email: &EZ—ti r_?&IDc9�'l DiSalvo, Diane From: Karen Szczotka <Karen@ribrownarchitect.com> Sent: Friday, October 29, 2021 3:08 PM To: DiSalvo, Diane Subject: RE: Olson Family 2020 Trust Approximately-465 feet as noted on Site Plan. Thanks have a great weekend From: DiSalvo, Diane<diane.disalvo@town.southold.ny.us> Sent: Friday, October 29, 20213:05 PM To: Karen Szczotka <Karen@ribrownarchitect.com> Subject: RE: Olson Family 2020 Trust I can just use this attached copy. But see my previous email—I do need that information which you can email to me. Diane From: Karen Szczotka <Karen@ribrownarchitect.com> Sent: Friday,October 29, 20212:58 PM To: DiSalvo, Diane<diane.disalvo@town.southold.nv.us> Subject: RE: Olson Family 2020 Trust Is it ok if I drop off the original and 3 copies off on Monday? From: DiSalvo, Diane<diane.disalvo@town.southold.ny.us> Sent: Friday,October 29, 20212:41 PM To: Karen Szczotka <Karen@ribrownarchitect.com> Subject: FW: Olson Family 2020 Trust The application is missing the short environmental form. Diane From: DiSalvo, Diane Sent: Friday, October 29, 20212:35 PM To: 'Karen Szczotka'<Karen@ribrownarchitect.com> Subject: Olson Family 2020 Trust Approximately how long will the proposed 4' wide foot path to the top of the bluff be? 1 Board of Trustees App?'` ,ation GENERAL DATA Land Area(in square feet): `�S Area Zoning: Previous use of property: Intended use of,property: C614 Covenants and Restrictions on property? Yes �_No If"Yes", please provide a copy. Will-this project require a Building Permit as per Town Code? Yes No If"Yes", be advised this application will be reviewed by the'Building Dept.prior to a Board of Trustee review and Elevation Plans will be required. Does this project require a variance from the Zoning Board of Appeals? Yes _JL,_No If"Yes", please provide copy of decision. Will this project require any demolition as per Town Code or as determined by the Building Dept.? Yes _No Does the structure`(s) on property have a valid Certificate of Occupancy? Yes No Prior permits/approvals for site improvements: Agency Date 164 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): Board of Trustees App,- ration WETLAND/TRUSTEE LANDS APPLICATION DATA Purpose of the proposed operations: f 4.o�) , Area of wetlands on lot: ,square feet Percent coverage of lot:. r _�% Closest distance between nearest existing structure and upland edge of wetlands:� 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: feet Proposed slope throughout the area of operations: Manner in which materia will be removed or deposited: Statement of the effect, if any, on the wetlands and tidal waters of the town that may result by reason of such proposed operations(use attachments if appropriate): p 617.20 Appendix 1i Short Erivironrnental Assessment Forret Instructions for ComMetin; Part 1 -Project Information. The applicant or project sponsor is responsible for the Completion of Part I. Responses become part of the application for-approval or funding,are subject to public review,and may be subject to further verificatidn. 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 -Proje'et and Sponsor Information Name of Action or P ojedtJ 20-2-0 h—n.c . Project Location(describe,and Attach a location map): Brief Description of Prop'Jkd Action: _ffo Name of Ajtplicttitt of Sponsor: W� Telephone: _ ?- �� 01T &4LE-Mail: 71L C�1?Y7 Address: cityQ; State: Zip Code: �064 11 1.Does the proposed action only involve the legislative adoption of a plan,local law,ordinance, NO YE& administrative rule,or regulation? If Yes,attach a narrative;description of the intent of the proposed action and the environmental resources that ❑ may be affected in the municipality and proceed to Part 2. If no,continue to"question 2. 2. Does the-proposed action require a permit,approval or funding from any other govennnental Agency? NO Y,ES If Yes,list agency(s)name and permit or approval: t -SCD ��r~ 2 ❑ 3.a.Total acreage of the site of the proposed action? ?7 acres b.Total acreage to be physically disturbed? ____f0 acres c.Total acreage(project site and any contiguous properties)owned or controlled by the applicant or project sponsor? _act es 4. Check all land uses that occur on,adjoining and neat the proposed action. 0 Urban ❑Rural(non-agriculture) ❑Industrial ❑Commercial EIResidential (suburban) ❑Forest `�i�Agriculutre ❑Aquatic (_]other(specify): ❑Parkland Page I of 4 i 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 ofthe existing built or natural � NO YES landscape? ❑ j 7. Is the site of the proposed action located in,or does it adjoin,a state Iisted,Critical Environmental Area? NO YES If Yes,identify: a • S. a;Will:tlie proposed action result in a substantial increase in traffic above present levels? N0 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? ❑ 9.5-0 the proposed,action meet or exceed the state energy code requirements? NO YES If the proposed action will exceed requirements,,describe design features and tdchnplogies:, 10. Will the proposed action connect to an existing public/private water supply?- 1' NO -YES If No,describe method for providing potable water: 1 ❑ 1 I,Will the proposed action connect to existing wastewater utilities? NO- YES ' If No,describe method for providing wastewater treatment: 0 12, a.Does`the site contain a structure that is listed on either the State or'National kegister of Historic NO' YL'S 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 notion,contain NO Y1 S 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 orwaterbody? ❑ If Yes,identify the wetland or waterbody and extent of alterations ift square•feet or acres: 14:Identify the typical habitat types that occur on,or are likely to be'found on the project site. Check all that apply: --shoreline -tali l"orest •—!�Agricultural/grasslands FEarly mid-successional ❑ Wetland' ❑Urban -[Suburban 1.5.Does the site of the proposed action contain any species of animal,,or associated habitats,listed NO YES by the State or Fedeia]government as threatened or endangercd9 1.6.Is the project site located in the 100 year flood plain? NO YES 17.Will(fie 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? ,E]NO ❑YES ❑ b.Will stoim water discharges be directed to established conveyance systems(runoff and storm drains)? If Yes,briefly describe: ONO ❑YES Page 2 of 4 S. does the proposed action Include construction or other activities that result in the Impoundment of T NO YES water or other liquids(e.g.retention pond,waste lagoon,dam)? If Yes,explain purpose and size: 19.Has the site of the proposed action or an adjoiningproperty.been the location of an active or closed NU YF.S solid waste management facility? IfYes,describe; __ e ry y F1 20.Has the site of the proposed action or an adjoining property been the subject of rernediation(ongoing or NO YES, completed)for hazardous waste? If Yes,describe: 1 AFFIRM THAT THE INFORMATION P11OVIDED.A BOVE IS TRUE AND ACCURATE TO THE BESTOF MY KNOWLEDGE C Applicant/spon or'ame. t ` Y Date: } �� Signatur l' vk• 0 Part-2-Ampaet.Assessment. The Lead Agency is responsible for,the completion of fart 2. Answer all of the following question's in=Part 2 using the information contained'in Part 1 afid 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 ititpact impact may stay occur occur 1. 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.characier or quality of the existing community? LJ 4. Will the proposed action have an impact on the environmental characteristics that caused the ('—j ❑ establishment of a_Critical Environmental Area,(CEA)? L�J 5. Will the proposed action result in an adverse change in the existing level of traffic 61- affect raffect 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? El 7. Will the proposed action impact existing: ❑ a.public/private water supplies? — LL b.public/private wastewater treatment utilities? S. Will the proposed action impair the character or quality of important historic,archaeological, (—j architectural or aesthetic resources? F-10 9. Will the proposed action result in an adverse change to natural resources(e.g.,wetlands, waterbodies,groundwater,air quality,flora and fauna)? El Pale 3 oF4 No,or Ntodcrate small to*large impact iratpact may array 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 ofsignificance. The Lead Agency is,responsible for the completion of fart 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,im pact mayor will;not be significant.Each potential impact should�e assessed considering, ts setting,probability of occurring, duration,irreversibility,geographic scope,and magnitude.,Also consider the potential for short-terns,long-term and cumulative impacts. Check this box,if you have determined,based on the information and analysis above,and any supporting documentation, t_ 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}ifyou have deterrnined,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 4 President Print or Type Name of Responsible Officer in Lead Agency Title of Responsible Officer w Signature of Responsible Officer in Lead Agency Signature of Prepater(if different from Responsible Officer) PRINT Page 4 of 4 Board of Trustees Pip, -'.cation AFFIDAVIT FIDA T �lBEING 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 RELIEF, AND THAT ALL WORD WILL BE DONE IN THE MANNER SET FORTH IN THIS APPLICATION AND AS MAY BE APPROVED BY THE SO OLD 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. " �,0 borl)) Signature of Prope Owner D SWORN TO BEFORE ME THIS DAY OF 6 C7d 9 rz7 P2— _ , 20 �"f PAIRICK T MARBURY Not ublic-State of New York NO.01MA6410904 Qualified in Suffolk County My Commission Expires Nov 9,2024 Notary Pu Ie Board of Trustees ApIz ,cation AU TION (where the applicant is not the owner) I,TDc-n IS o() �-z=a y aoaa Tom±residing at_I�1—� (print name of owner of property) (mailing address) ICES �c S . ,a l 7ST do hereby authorize �IAW (.Agent) et�dP-- jKjP to apply for permit(s)from the Southold Board of Town Trustees on my behalf. D/ .x �-,�t c,.-k (Owner's signature) APPLICANTIAGENTIREPRESENTATWE TRANSACTIONAL DISCLOSURE.FORM The Town of Soutbold's Code of Ethics prohibits conflicts of interest on the part of town 6f4icers and employees.The purpose of this form is to provide inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is necessaryo avoid same. YOUR NAME: Ism rr m t �J 20 D 7J-2a-s+- j,(Last name,firstna��ddie 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 ofZone 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 applicanttagcnt/representative)and the town officer or employee.Either check the appropriate fine 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 applievint (when the applicant is a corporation); a B)the legal or beneficial owner of any interest in a non-corporate entity(when the applicant is not a corporation); �V C)an officer,director,partner,or employee of the applicant;or D)the actual applicant. DESCRIPTION OF RELATIONSHIP Submitted this day of 04 20 Signator t - - Form TS I APPLICANT/AGENT/REPRESENTATIVE TRANSACTIONAL DISCLOSURE,FORM The Town of Southold's Code of Ethics•prohibits conflicts of interest on the part of town officers and employees.The purpose of this form is to provide,inforination which can alert the town of possible conflicts of interest and allow it to take whatever action is ,necessary,to avoid same. YOUR NAME: &6.L)-n i &&A, - (Last name,first name:.nidd 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,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 �V If you ans%vered"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/agQnt/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 thisof 209,J Signature t. Print Name Ak Form TS 1 APPLICANVAGENURE PRESEN'] ATIVE TRANSACTIONAL DISCLOSUn,FORM The Town of Southold's Code of Ethics prohibits conflicts of interest on the part of town Officers and employees.The purpose of this form is toprovide information which can alert the town ofposs1ble conflicts-of interest and allow it to take whatever.action is necessary to•avoid satire; YOUR NAME: _ (Last name,first name, �nitida tnitial,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,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 day 20 Signature Print Name Form TS l Town of Southold 1LWRP CONSISTENCY ASSESSMENT FORINT 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 Townl. 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, listinE 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# 73 PROJECT NAME The Application has been submitted to (check appropriate response): Town Board ❑ Planning Board❑ Building Dept. ❑, Bo rd f 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: FV Nature and ext f action: ` Location of action: Site acreage: Present land use: A/ Z Wd Present zoning classification: 2. If an application for the proposed action has been filed with the Town of Southold agency, the following information shall be provided: (a) Name of applicant:��Clj (b) Mailing address: aad (c) Telephone number: Area Code (d) Application number, if any: Will the action be directly undertaken,require funding, or approval by a state or federal agency? Yes ❑ NOPI'' 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. ❑Yes [] 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 Yes ❑ No� Not Applicable Attach additional sheets if necessary Policy 3. Enhance visual quality and protect scenic resources throughout the Town of Southold. See LWRP Section III—Policies Pages 6 through 7 for evaluation criteria ❑ Yes ❑ N,p,,ffl Not Applicable Attach additional sheets if necessary NATURAL COAST POLICIES Policy 4. Minimize loss of life, structures, and natural resources from flooding and erosion. See LWRP Section III—Policies Pages 8 through 16 for evaluation criteria ❑ Yes ❑ No �2 Not Applicable Attach additional sheets if necessary Policy 5. Protect and improve water quality and supply in the Town of,Southold. See LWRP Section III —Policies Pages 16 through 21 for evaluation criteria Yes ❑ No /M 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 _ __ Applicable Attach additional sheets if necessary — Policy 7. Protect and improve air quality in the Town of Southold. See LWIZP Section III — Policies Pages 32 through 34 for evaluation criteria. ❑ Yes ❑ NA 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. ❑ Yes ❑ 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. ❑ Ye No❑ Not Applicable Attach additional sheets if necessary WORDING COAST P�,_�CIES Policy 14. 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 q Not Applicable Attach additional sheets if necessary Policy 11. Promote sustainable use of living marine resources in Long Island Sound, the Peconic Estuary and Town waters. See LWRP Section III—Policies; Pages 57 through 62 for evaluation criteria. ❑ Yes ❑ No N 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❑ 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 L4 Not Applicable PREPARED B TITLE DATE ROBERT I. BROWN, ARCHITECT P.C. 205 BAY AVENUE GREENPORT, NY 11944 631-477-9752 FAX 631-477-0973 info(@ribrownarchitect.com Transmittal Date: October 27, 2021 To: Southold Town Trustees P.O. Box 1179 Q ^ � Southold,N.Y. 11971 OCT 2 9 2021 Re: Olson Family 2020 Trust C Deborah Olson, Trustee Southold Town 14995 Oregon Road Board of Tru Mees Cutchogue,N.Y. __ SCTM#: 1000-73.-1-2.2 Enclosed please find application for the above referenced. We are proposing to clear a four(4) foot path to the top of the bluff. We have not included pictures at this time because the property is too overgrown to access the area. Thank you, ,r Karen Szczotka, Agent for Robert I. Brown Architect, PC